Chest pain is an important feature of acute myocardial infarction in young and middle-aged patients, but this symptom is not prominent in elderly patients, and the incidence of absence of chest pain increases with increasing age. This is because the absence of chest pain is one of the important features of elderly patients, especially those of advanced age. Painlessness is mostly seen in elderly patients with diabetes mellitus, smoking, cerebral circulation disorders, cardiac complications (heart failure, shock, severe arrhythmias) and right coronary artery obstruction. Although there is no chest pain in elderly acute myocardial infarction, there may be other parts of pain (abdominal pain, toothache, shoulder pain, etc.) or other symptoms (chest tightness, breath-holding, nausea, vomiting, shock, etc.). The elderly should be alerted to the possibility of acute myocardial infarction if they develop the above symptoms, but they can also be completely free of any pain or symptoms. Heart failure as the first symptom of acute myocardial infarction is very common in elderly patients. The incidence of heart failure in elderly patients is 2-5 times higher than that in young and middle-aged people, and its degree is more severe than that in young and middle-aged people, which may be due to pre-existing coronary artery disease and myocardial changes that reduce myocardial diastolic and systolic functions. Elderly people should think about the possibility of heart failure-type myocardial infarction if they have heart failure manifestations such as chest tightness, breathlessness, palpitations and dyspnea, especially if their hearts are not large without obvious causes. Acute myocardial infarction in the elderly starts with symptoms such as impaired consciousness, syncope and stroke, and its incidence is significantly higher than that of middle-aged and young people. Strokes are more common with cerebral infarction and less common with cerebral hemorrhage and subarachnoid hemorrhage. Cerebral and cardiac symptoms may occur simultaneously or sequentially, but most often the cerebral symptoms mask the cardiac symptoms. It is mostly seen in elderly people with significant cerebral atherosclerosis. Once acute myocardial infarction occurs, it can lead to insufficient blood supply to the brain or stroke due to blood pressure fluctuation, shock, severe arrhythmia, and dislodgement of left ventricular appendage thrombus. Stroke can also cause vasomotor center disorders (hypotension) leading to acute myocardial infarction. The coexistence of acute myocardial infarction and stroke has a significantly higher mortality rate than the acute myocardial infarction alone group, indicating that the coexistence of the two has a poor prognosis and warrants attention. The electrocardiogram and myocardial enzymology should be closely monitored clinically in elderly people with neuropsychiatric symptoms.