Acute Coronary Syndrome Presenting as Acute Diarrhea in a Previously Healthy 38-Year-Old Man: A Rare Diagnostic Challenge.

Acute coronary syndrome (ACS) is a life-threatening condition that typically presents with chest pain, dyspnea, or chest discomfort. However, atypical manifestations occur in a considerable proportion of patients and may lead to delayed diagnosis and treatment. Gastrointestinal symptoms such as nausea and vomiting are relatively common in inferior wall myocardial infarction, whereas diarrhea is an extremely rare presenting symptom. We report the case of a 38-year-old man with no known past medical history who presented to the emergency department with multiple episodes of acute diarrhea without abdominal pain or chest discomfort. Initial clinical evaluation suggested acute gastroenteritis; however, electrocardiography revealed ST-segment elevation in the inferior leads. The patient was diagnosed with ST-elevation myocardial infarction (STEMI) and received immediate treatment including dual antiplatelet therapy and thrombolysis, followed by coronary angiography and stent placement in the right coronary artery. This case highlights the importance of considering atypical presentations of ACS in emergency settings and emphasizes the role of early electrocardiographic evaluation even in patients presenting with non-cardiac symptoms.