Diagnostic and Management Challenges of Myocardial Infarction in a Nigerian Primary Health Care Centre: A Case Report

Abstract

Background: Myocardial infarction is becoming more prevalent in low and middle income countries (LAMICs). The presentation of MI is occasionally obfuscated by other diseases such as dyspepsia and peptic ulcer disease. Moreover, management in LAMIC is complicated by poor diagnostic and therapeutic options as well as delays in seeking and instituting health care intervention. This results in relatively high disease burden with a corresponding increase in mortality and morbidity. Aim: The aim of this case report was therefore to describe the challenges associated with diagnosis and management of myocardial infarction in a primary health centre (PHC) in Nigeria. Case Presentation: A 34 year old female patient who presented with a 6 month history of recurrent epigastric pain, exacerbated in the immediate 1 week period prior to presentation and managed as an inpatient at a primary health care centre in Nigeria. She was stabilized and investigated for MI using a full blood count and lipid profile, as certain vital investigation modalities such as ECG and other biochemical investigations such as troponins, CKMB or other cardiac biomarkers of MI were not readily accessible, before a presumptive diagnosis was made and ultimate referral to a tertiary health care facility done. Patient did very well on treatment, and was counter-referred to the PHC six months later on basis of proximity, with follow-up instructions suggestive of confirmation of diagnosis and management of MI. We discuss the epidemiology, diagnostic limitations and delays, as well as differential diagnoses of MI in a PHC setting. We further highlight the need for availability of affordable and efficacious therapeutic or preventive options for management of MI in LAMICs. Conclusion: Management of MI in a LAMIC is challenging. With an increasing incidence, it is incumbent upon primary care physicians to diagnose, stabilize and refer such patients to appropriate levels of care. The index case was managed as a case of MI and ultimately referred to a tertiary care centre after a brief stay in the PHC.