Abstract
The presentation of retrosternal chest pain with normal electrocardiogram (ECG) during chest pain followed by initial presentation of acute pancreatitis can lead to a dilemma in managing such a patient, and whether to thrombolyse such a patient is a real controversy. We hereby present a similar case who was diagnosed to be having acute pancreatitis on admission, on clinical grounds, confirmed by laboratory investigations and ultrasonography, who subsequently developed retrosternal chest pain with normal ECG during the chest pain. All further serial ECGs after the onset of chest pain were within normal limits. The troponin-I level of this patient was positive twice (done 16 h apart). The patient was treated as acute coronary syndrome along with the standard management protocol of acute pancreatitis.