The patient is an 83-year-old female who presented to an outside rural hospital emergency department with a complaint of nausea and chest discomfort of one-day duration. Her medical history included hypertension, hyperlipidemia, carotid artery stenosis, traumatic subarachnoid hemorrhage, transient ischemic attack, and paroxysmal atrial fibrillation. She is a nonsmoker. On exam, she was normocardic with a regular rhythm. The rest of her vital signs were normal. Laboratory investigation revealed white blood cell count 6.9 K/uL, hemoglobin 14.6 g/dL, platelet count 170 K/uL, lipase 21, and an abnormal troponin level 0.180 ng/mL. An electrocardiogram (ECG) obtained reveal normal sinus rhythm, pulse rate 60. The emergency department physician diagnosed non-ST elevation myocardial ischemia (NSTEMI). Her chest discomfort improved with administration of nitroglycerin and morphine; anticoagulation with heparin drip was initiated and she was transferred to our facility. Her home medications include baby aspirin, metoprolol, and ramipril.