A Rare Presentation of Acute Coronary Syndrome, in a Patient of Amputation of Right Forearm: A Case Study.

Abstract

A patient presented with sudden onset right-sided chest pain in the emergency department. He had a past history of amputation of his right forearm due to trauma 25 years back. Phantom limb pain was suspected, but on investigations, he was diagnosed with acute coronary syndrome with unstable angina. The patient was treated in ICCU ECG and ECHO were done.ECG report showed T wave inversion in V3-V6 precordial leads with ST elevation (fixed change). A coronary angiogram was done and minor CAD was detected(LAD minor blockage). ECHO report showed mild tricuspid regurgitation, concentric LVH, EF-64%. Blood pressure was 150/90mm Hg, pulse rate-103/minute and Trop T was negative on admission in iccu. The patient’s lipid profile, thyroid function test, kidney function tests, FBS, and PPBS was done and reports were normal.. Patient on discharge was advised oral medications like aspirin. clopidogrel, atorvastatin, angiotensin receptor blocker and nitroglycerine tablets. On discharge salt-restricted diet and two weeks of bed rest were advised. The theory of past experiences, denervation hypersensitivity and cortical plasticity might be the contributors of such atypical angina pain presentation which overruled the dermatomal rule. The study highlighted on atypical presentation of ACS as cardiac pain radiated in the right side in a special scenario of amputation of the right upper limb below the elbow. Differential diagnosis : Costochondral chest pain, Dextrocardia, Pericarditis, pneumonia, esophageal disease. The phantom limb component of referred pain radiates to the right side