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

Lorenzo Storari; Valerio Barbari; Fabrizio Brindisino; Marco Testa; Maselli Filippo

doi:10.1186/s40945-021-00099-x

Authors

Lorenzo Storari Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
Valerio Barbari Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
Fabrizio Brindisino Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
Marco Testa Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
Maselli Filippo Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy

DOI:

https://doi.org/10.1186/s40945-021-00099-x

Keywords:

Anterior wall myocardial infarction, Differential diagnosis, Referral and consultation, Shoulder pain, Physiotherapy

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.