2012  •  

Differential Diagnosis: Musculoskeletal Pain vs. Cardiogenic Pain

Lead Presenter: Michelle Perry

Background and Purpose: Although research has improved our understanding of the structure and function of the cardiovascular system, little is known regarding the prevalence of atypical presence among patients with unstable angina pectoris. Cardiovascular disease can present in an extensive array of symptoms, thus making differential diagnosis particularly challenging. Case Description: A 55-year-old male presented to the emergency department with dyspnea and right shoulder pain. After acute myocardial infarction was ruled out, the patient was referred for magnetic resonance imaging. Results confirmed the patient had a partial tear of the supraspinatus tendon. After numerous follow-up appointments, a stress test was suggested to rule out cardiac involvement before proceeding with surgery. The stress test revealed an inadequate oxygen supply to the left ventricle of the heart, and the patient was referred for angioplasty and stent placement in the blocked artery. However, the stent failed, which further resulted in an emergency double coronary artery bypass graft. Discussion: It is important to recognize red flags and accurately differentiate musculoskeletal symptoms of a systemic origin. Delay or failure to recognize unstable angina may eventually lead to myocardial infarction and even death. Being able to better recognize patients with both typical and atypical presentations of cardiac disease as well as its associated risk factors can save lives and reduce the overall prevalence of heart disease in the United States. Level of Evidence: Case Report Key Words: angina pectoris, differential diagnosis, chest pain, unstable angina, cardiac disease, acute coronary syndrome, cardiovascular risk factors, coronary artery disease.