A recent patient, in his 50s, had been in good health before, but about a week ago, in the evening, after dinner, he had pain in his upper abdomen, with intermittent discomfort, and the next day, there was no relief, so he went to the local hospital for examination. The pain subsided after a few hours, but the discomfort was still there. A week later, the pain was still there and was often accompanied by chest tightness and shortness of breath, so he came to Shanghai for a checkup. The coronary angiogram showed 50%-60% stenosis in the proximal left anterior descending branch, 80% stenosis in the right coronary artery opening, and 50%-60% limited stenosis in the posterior descending branch. The patient was not aware of it before and simply thought it was a “stomach problem”, which delayed the treatment. In fact, a simple electrocardiogram would have revealed the problem at that time. This patient’s case is actually a wake-up call for us. We all know that the typical symptoms of coronary heart disease are commonly chest pain or chest discomfort, etc., which are relatively easy to attract the attention of patients. However, there are a few patients with coronary heart disease whose symptoms are often atypical, so not only do patients often take them lightly, but even doctors are prone to misdiagnosis, thus delaying the timely treatment of the disease. In outpatient clinics or emergency departments, only about 20% of chest pains are caused by ischemic heart disease, which easily leads to overdiagnosis of coronary heart disease; some patients with coronary heart disease may show discomfort in the throat, upper abdominal pain, back pain, toothache, headache or even leg pain, which often leads to missed diagnosis. The older a person is who suffers from geriatric myocardial infarction, the more painless it is, so he or she should be more alert. Electrocardiogram should be performed in all elderly people with any clinical symptoms and when symptomatic treatment is ineffective. Also coronary artery disease combined with diabetes and pulmonary heart disease is predominantly asymptomatic. Therefore, middle-aged and elderly people with long-term hypertension, hyperlipidemia, smoking and diabetes should undergo relevant examinations regularly to prevent missed diagnosis. Just like the patient in the case I mentioned, he was a little bit older, but there were no other risk factors for coronary heart disease, and the epigastric pain was not in line with typical ischemic chest pain characteristics, so the local doctor gave the diagnosis of gastric disease, and the patient himself was not strongly aware of the persistent discomfort symptoms and did not do further examination to clarify them, so he was misdiagnosed and thus his treatment was delayed. Some patients like to be brave and do not go to the hospital for checkups when they are unwell, or even do not talk to their families, which can delay the best time for treatment if it is a heart disease. The atypical clinical symptoms of coronary heart disease: 1, the angina site occurs outside the chest, manifested as headache, toothache, sore throat, shoulder pain, leg pain, often need to be distinguished from the corresponding organs caused by discomfort. 2, manifested as epigastric distension and discomfort and other gastrointestinal symptoms, especially when the pain is severe, often accompanied by nausea and vomiting, clinically easy to misdiagnose as acute gastroenteritis, acute cholecystitis, pancreatitis. 3.Some patients with coronary heart disease do not have chest pain, but only show various arrhythmias such as atrial fibrillation, ventricular premature, atrioventricular block, or shortness of breath, nocturnal paroxysmal dyspnea and other heart failure manifestations as the first symptoms, which is clinically called “arrhythmia and heart failure coronary heart disease”, a rare type of coronary heart disease. 4, a few patients with coronary heart disease, especially in acute myocardial infarction, only appear the manifestations of cerebrovascular disease, such as dizziness, limb paralysis, sudden loss of consciousness and convulsions and other cerebral circulation disorders, because of myocardial infarction, or because of cerebral vasospasm, severe arrhythmias often lead to reduced blood supply to the brain. Therefore, when elderly people have cerebrovascular spasm, they should have an electrocardiogram and be followed up within a short period of time to exclude the possibility of acute myocardial infarction. If coronary heart disease is combined with other acute diseases, such as diabetic ketoacidosis, acute infection and surgical emergencies, even if acute myocardial infarction occurs, the symptoms are often masked. Therefore, patients and their families should reflect the condition of coronary heart disease to the doctor in time to provide reference to the doctor. 6.Since the elderly often have memory loss, dull senses and are not good at expressing symptoms, they are easy to be ignored by family members and doctors, so don’t forget to do a routine electrocardiogram when doing relevant examinations for the elderly. I suggest that an ECG should be done after going to the hospital or clinic if you have any uncomfortable symptoms. It is certainly more necessary for patients with a history of disease or underlying factors. An ECG or series of ECGs will alert the physician to this pitfall that exists and will greatly reduce the number of missed coronary heart disease diagnoses.