Cases & Commentaries
Presenting with pain in her epigastric region and back, an older woman with a history of opioid abuse had abnormal vital signs and an elevated troponin level. Imaging revealed multiple spinal fractures and cord compression. Neurosurgery recommended conservative management overnight. However, her troponin levels spiked, and an ECG revealed myocardial infarction. In the accompanying commentary, Maria C. Raven, MD, MPH, MSc, of UCSF, reviews challenges to caring for individuals with frequent emergency department visits, particularly diagnostic overshadowing, and describes interventions to improve diagnosis for such patients with mental illness or substance use disorders.