Case Report: A four-stage diagnostic cascade: from coronary stents to pancreatic cancer in a patient with recurrent chest pain

Chest pain sends millions to emergency rooms, yet its source can be surprisingly elusive. While the focus often falls on the heart, the abdomen can produce pain that perfectly mimics angina, leading clinicians down a deceptive path. This diagnostic trap becomes even more dangerous when a patient already has known coronary artery disease, as familiar symptoms may mask a completely different threat. We present a case that unfolded in an unexpected sequence. A patient with recurrent chest pain underwent coronary stenting, only to have the same pain return soon after. What followed was a clinical puzzle that gradually uncovered not one, but two additional diagnoses-each one more surprising than the last, and each demanding a fundamental shift in thinking. The journey from the catheterization laboratory to the final answer holds sobering lessons about cognitive anchoring, the value of overlooked laboratory clues, and the need to look beyond the heart when chest pain refuses to resolve.