Question: An 84-year-old woman with a history of dementia and gastroesophageal reflux disease presented to the emergency department with several hours of worsening chest and epigastric pain associated with nausea and vomiting. Upon arrival she was hypertensive to 218/110 mm Hg and had a low-grade fever of 37.8°C. Physical examination was remarkable for epigastric tenderness in a cachectic, elderly woman with mild cognitive impairment. Electrocardiogram and cardiac enzymes ruled out acute coronary syndrome.