Hi, Thanks for writing in. I am a qualified and certified cardiologist and I read your mail with diligence. Patients are brought to ER with chest pain first and foremost priority for them is to rule in or rule out a heart attack. The criteria cardiologist follow to diagnose a myocardial infarction or acute coronary syndrome are two out three are abnormal (supporting the diagnosis of ischemic heart disease not supporting are called normal whether they support other conditions like hypertension with left ventricular hypertrophy as was in your case will be called normal keeping in mind it is ischemic heart disease you are looking for in ER): 1. Typical chest pain retro sternal, central squeezing, associated with shortness of breath, radiating to neck or left arm, associated symptoms like sweating may be present. 2. EKG changes suggestive of ischemia that is ST changes elevation to begin with associated with upright T later on ST settling with T wave inversion and appearance of q wave 3. Cardiac enzymes elevation serum myoglobin, serum creatine phosphokinase myocardial fraction CPK-MB or Troponin T or I quantitative assay. If two out three criteria are met a diagnosis of acute mayocardial infarction is made. Oher reports are called atypical or normal it is the purpose of sorting out patients who need immediate treatment. Others are assigned to less acute urgency of treatment and perhaps erroneously called normal . In the emergency errors like yours can occur in the endeavor to identify and help those who need it first. I am only giving explanation for your interpretation which is slightly different from mine, the emergency doctor had labelled a cardiac patient who also needs attention (not on high priority as the first doctor thought : an unintentional error of judgement perhaps which was corrected by a supervising cardiologist). I hope will understand nothing was an intentional and negligence. With Best Wishes. Dr Anil Grover