Silent inferior wall myocardial infarction presenting as dizziness and vomiting in a diabetic patient at high altitude: A case report

Acute myocardial infarction (AMI) can present atypically, especially in elderly and diabetic patients. We report a 64-year-old diabetic ex-serviceman at high altitude who presented with dizziness and vomiting, without chest pain. Initial electrocardiogram (ECGs) were non-diagnostic, but serial tracings revealed inferior wall ST-elevation myocardial infarction (STEMI). Due to the unavailability of thrombolytics at the primary care level and challenging terrain, thrombolysis was delayed until transfer to a higher center. This case emphasizes the importance of high suspicion, serial ECGs, and preparedness for cardiac emergencies in resource-limited, high-altitude settings.