Persistent epigastric pain in an 80-year-old man.

one-week history of constant epigastric pain and left-sided exertional chest pain. On the day of presentation, he had experienced four episodes of nonbilious vomiting, but had no other gastrointestinal symptoms. He did not report fever, chills or sweats. There was no history of recent travel or contact with an ill person. His medical history included hypertension, type 2 diabetes mellitus, dyslipidemia, prior myocardial infarction with left ventricular dysfunction, and a left hemicolectomy for adenocarcinoma of the colon, which was in remission. He was afebrile, his heart rate was 112 beats/ min and his blood pressure was 123/71 mm Hg. Except for mild tenderness in the upper abdominal quadrants, his physical examination was normal. The results of laboratory investigations are summarized in Table 1. Electrocardiography showed a first-degree atrioventricular block with sinus bradycardia. The patient was admitted with a diagnosis of non–ST-segment elevation myocardial infarction and received evidence-based therapies. His chest pain resolved; however, his epigastric pain persisted.