A 44-year-old female awakened with shortness of breath complaining of indigestion, nausea, and epigastric pressure. Antacids didn't help. You should suspect?

The symptoms described in this scenario—shortness of breath, indigestion, nausea, and epigastric pressure—are strongly indicative of a myocardial infarction (heart attack). In many cases, particularly in women, the presentation of a heart attack can be atypical and may not include the classic chest pain. Instead, symptoms can mimic gastrointestinal issues, leading to confusion in diagnosis.

The patient's report of indigestion and no relief from antacids is particularly significant. While gastrointestinal problems may cause similar complaints, the combination of nausea, epigastric pressure, and shortness of breath raises serious concern for cardiac involvement. This is especially pertinent in someone of the patient's age and gender, where risk factors for coronary artery disease might be present.

Prompt recognition of these symptoms as potential indicators of a myocardial infarction is crucial for a timely and appropriate response, which may include immediate medical intervention to minimize heart damage and improve outcomes.