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. 2021 Feb 15;11(1):5.
doi: 10.1186/s40945-021-00099-x.

An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report

Lorenzo Storari  1 , Valerio Barbari  1 , Fabrizio Brindisino  2 , Marco Testa  1 , Maselli Filippo  3
Affiliations

An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report

Lorenzo Storari et al. Arch Physiother. .

Abstract

Background: Shoulder pain (SP) may originate from both musculoskeletal and visceral conditions. Physiotherapists (PT) may encounter patients with life-threatening pathologies that mimic musculoskeletal pain such as Acute Myocardial Infarction (AMI). A trained PT should be able to distinguish between signs and symptoms of musculoskeletal or visceral origin aimed at performing proper medical referral.

Case presentation: A 46-y-old male with acute SP lasting from a week was diagnosed with right painful musculoskeletal shoulder syndrome, in two successive examinations by the emergency department physicians. However, after having experienced a shift of the pain on the left side, the patient presented to a PT. The PT recognized the signs and symptoms of visceral pain and referred him to the general practitioner, which identified a cardiac disease. The final diagnosis was acute myocardial infarction.

Conclusion: This case report highlights the importance of a thorough patient screening examination, especially for patients treated in an outpatient setting, which allow distinguishing between signs and symptoms of musculoskeletal from visceral diseases.

Keywords: Anterior wall myocardial infarction; Differential diagnosis; Physiotherapy; Referral and consultation; Shoulder pain.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Body chart. Symptoms at 1st ED visit. In red NPRS 8/10 at rest
Fig. 2
Fig. 2
Body chart. Symptoms at 2nd PT visit. In red NPRS 9/10 at rest
Fig. 3
Fig. 3
ECG: Sinus Rhythm, 85 bpm, pathological-Q waves in leads I, aVL and the precordial lead V4 with ST-segment elevation in the corresponding leads, ST-segment depression in DIII (anterolateral myocardial infarction)
Fig. 4
Fig. 4
LAD flow showed by coronary angiography with contrast dye. a Thick yellow arrow indicates percutaneous transluminal coronary angioplasty, with catheter system that it is introduced through a systemic artery under local anesthesia a stenotic LAD coronary artery. b Thick yellow arrow indicates dilate the stenotic artery by controlled inflation of a distensible balloon. c Thick yellow arrow indicates the disappearance of stenosis and artery flow restoration
Fig. 5
Fig. 5
Timeline
See this image and copyright information in PMC

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