A MYOCARDIAL INFARCTION CASE PRESENTING TO EMERGENCY SERVICE WITH SHOULDER PAIN Serkan SUNGUR¹, Burcu KÖKOĞLU¹, Mehmet KAYHAN¹, İlhami ÜNLÜOĞLU¹ 1 Eskişehir Osmangazi University Medical Faculty, Department of Family Medicine CASE REPORT A 54 year old male patient was brought to the emergency room by ambulance complaining with an 1,5 month history of shoulder pain, which worsened over the last 2to3 days. Upon arrival he was alert, oriented and cooperative. The patient described pain in both shoulders and arms, worsened upon movement and gradually exacerbating. There was nothing special about personal and family medical history. Cigarette consumption of 20 packages-per-year was found out. On physical examination, his blood pressure was 140/90 mmHG and pulse was 72 beats/min. Lungs were clear to auscultation and he had a regular rate and rhythm without murmur. Peripheral pulses are palpable and symmetrical bilaterally. There was no sign of juguler venous distention observed. Rebound tenderness, defence or organomegaly weren’t present.   Figure 1 : ECG at arrival Performed laboratuary tests showed no anomaly in hemogram and biochemistry. Miyoglobin: 331ng/ml, CK-MB: 5,71 ng/ml, troponin-T: 0,036 recorded but since he hasn’t any chest pain, the patient was monitorized and was taken to the emergency care unit, after a 2-hour evaluation he lost consciousness when control ECG was performed. The patient was defibrilated as VF rhythm was seen on monitor, after 2 minutes of CPR he returned to sinus rhythm, and regained consciousness. ST elevations were observed on V1 to V4 derivations in performed ECG. Patient is prediagnosed as large acute anterior myocardial infarction. After cardiology consultation patient is sent to angiography. Figure 2 : ECG after two hours Table: Presenting symptoms of acute coronary syndrome in order of appearance Acute coronary syndromes are mostly presented to the emergency room with chest pain often radiating to the left arm or angle of the jaw, and associated with nausea and sweating. In addition to these, symptoms like back pain, diaphoresis, dyspnea, vomiting, dizziness, abdominal pain, syncope can occur. Family physician residents rotate through the Emergency Room. Given the high prevalence of acute coronary syndrome in the emergency department, we can emphasize that chest pain is not the only sign of coronary syndromes. Keywords: anterior myocardial infarction, shoulder pain