Case Report: Differential Diagnosis of a Complex Postpartum Patient with Cardiac Symptoms

Background: This case report describes the physical therapy differential diagnostic and clinical decision-making processes utilized in the management of a complex post-partum patient.This case is significant in that it demonstrates how multiple physical and physiological systems can overlap with a mechanical abnormality that would often be difficult to differentially diagnosis.Case presentation: A 31-year-old female patient with an initial presentation of shoulder and thoracic pain that progressed into symptoms similar to those of myocardial infarction (MI).She was initially medically diagnosed with Gastroesophageal Reflux Disease (GERD) and anxiety, though symptoms were unresolved after addressing this with positional and dietary changes.Medication was refused.After multiple events, imaging, testing, and further systems review, the symptoms she described and the objective findings led her clinical team to determine she suffered from vagal nerve entrapment at the esophageal hiatus, which was successfully treated by the physical therapist in conjunction with chiropractic care.Discussion: Over a period of 23 days and 5 physical therapy sessions, a visit to the local emergency department, a visit to the patient's primary care physician a visit to a cardiologist, and an evaluation by a chiropractor, a diagnosis and treatment plan was developed and carried out.The patient management approach included examination (subjective and physical), evaluation of findings, medical and physical therapy diagnoses, prognosis, plan of care, intervention, and evaluation of outcomes.Conclusion: This case report demonstrates the need for physical therapists to incorporate a comprehensive patient management approach in order to efficiently maximize patient outcomes, and also places the challenge on physical therapists to engage in interprofessional care for differential diagnosis, imaging, and expertise outside the PT/PTA scope of practice.It also demonstrates the need for physical therapists to be more aware of overlapping physical, mechanical and physiological systems during evaluation.