Challenges and Implication of Atypical Presentation of Acute Myocardial Infarction in Peripheral Sub-Saharan Africa: A Case Report

Abstract

This case study presents the clinical course of a 50-year-old female patient with a delayed diagnosis of Acute Myocardial Infarction (AMI) and highlights the challenges in accurately identifying cardiac pathology in patients presenting with atypical symptoms. Patient’s initial presentation with non-exertional left-sided chest pain, radiating to the left arm, raising concerns of a cardiac aetiology. At the peripheral center, an initially normal electrocardiogram (ECG) led to an alternative diagnosis of nerve impingement from the cervical spine. Despite further evaluations and interventions, including imaging tests, physiotherapy, and regular follow-up, the patient’s symptoms persisted. Eventually, at The Karen Hospital (TKH), an ECG revealed an anterior infarct with septal akinesia on 2D Echo, leading to an accurate diagnosis and successful Percutaneous Coronary Intervention (PCI) to the left anterior descending artery. We aim to shed light on the challenges and implications of delayed suspicion and diagnosis of acute myocardial infarction in sub-Saharan Africa. This case emphasizes the importance of considering AMI as a potential cause of chest pain, even in the absence of typical risk factors, and highlights the significance of timely and accurate diagnosis in improving patient outcomes.