A patient presented to our hospital with general fatigue and shock. Anterior ST-segment elevation was observed on the electrocardiogram (ECG), initiating the chest pain protocol. Subsequent findings included elevated troponin levels and dynamic ECG changes with further ST-segment elevation on a repeat tracing. A preliminary diagnosis of cardiogenic shock secondary to acute anterior ST-segment elevation myocardial infarction (STEMI) was made. However, coronary angiography revealed no significant stenosis, ruling out myocardial infarction. Combined with elevated inflammatory markers, a diagnosis of septic shock was established. The ST-segment elevation resolved on follow-up ECG as the patient's clinical condition improved. In the chest pain center setting, differentiating between cardiogenic shock with ECG ST-segment elevation and septic shock can be challenging. Timely recognition and targeted treatment are crucial for improving patient outcomes.

To be updated