Cardiac Disorders Case Study

 The following Case Studies are from actual cases handled by The Cochran Firm - Metairie attorneys.

Failure to Diagnose Heart Attack In Women

A 45 year old white female began to experience mid-sternal “sharp” chest pain that radiated into both arms.   She took a family member’s (her father’s) nitroglycerin tablet without obtaining any pain relief.  She was emergently taken by ambulance to hospital, and arrived in the emergency room at approximately 11:21 p.m.  Significantly, the ambulance records reflect that patient’s chief complaint was mid-sternal chest pain which radiated into her arms and had not been relieved by her taking nitroglycerin given to her by her father.  Upon arrival at the emergency room, the triage nurse also specifically noted that patient’s chief complaint was “Chest Pain- midsternal radiating to both arms, onset 20:00”. The triage nurse recorded that the pain rated a “10” on a severity scale of 1-10.   The emergency room record also reflected that patient had taken 2 nitroglycerin tablets and 4 baby aspirin without relief.  Her blood pressure was recorded at 142/82, pulse 85 respirations 21.

According to her past medical history, patient was a smoker, she was obese, weighing 160 lbs, had a history of hypertension.  She was also a type II diabetic.  Her father also had a history of heart trouble, which was the source of her obtaining the nitroglycerin tablets.  Dr. saw patient for the first time at approximately 23:45 and ordered blood drawn, including cardiac enzymes and a single EKG.  recorded that patient had a history of “epigastric pain and sternal area sharp pleuritic chest pain.  Around epigastric pain resolved, but not the chest pain.”   

The ECG was read as “non specific ST and T wave abnormality, abnormal ECG.”  The blood work, specifically the cardiac enzymes, were essentially normal.  Patient was given a GI cocktail and discharged from the hospital emergency room at approximately 01:10 on the early morning of February 8, less than 2 hours after she arrived. No serial EKG’s or serial cardiac enzyme studies were ever ordered or performed at Dr.’s request. She was not admitted to the hospital for cardiac consultation and no cardiologist was consulted during her evaluation in the emergency room.

 

At approximately 10:00 a.m. on February 8, patient was found in the hallway of her residence unconscious and in V-Fib.  An ambulance was called and she was shocked multiple times while being emergently transported back to the emergency room of hospital where she was diagnosed with an anterolateral infarct.  She was treated in the cardiac catheterization lab for coronary artery disease.  She suffered severe hypoxic encephalopathy and remained unresponsive until her death on March 9.  The causes of death listed on the death certificate are:  Hypoxic encephalopathy, ventricular fibrillation, acute myocardial infarction. 

Defendants breached the standard of care in their treatment of patient by committing the following acts and omissions, all of which constitute negligence and wrongful conduct for which defendants are liable:   

    

1.                  Dr. failed to perform an  adequate and  more thorough workup of patient’s obvious cardiac signs and symptoms;

2.                  Dr. failed to obtain a cardiology consultation;

3.                  Dr. failed to obtain serial cardiac isoenzyme markers or serial EKG’s;

4.                  failed to admit patient to the hospital for further observation of her chest pain;

5.                  According to Dr., the nurses and/or other employees of hospital failed to provide Dr. with medical information about patient, which Dr. says would have changed his treatment of patient.

6.                  Dr. failed to obtain the information which was recorded in patient’s chart and readily available to him.

7.                  Dr. discharged patient from the hospital emergency room prematurely;

 

The patient was again motivated to intinsify life style changes. Specifically, he was strongly recommended to increase physical activty (two to three times per week 45 to 60 minutes endurance training). For lowering cholesterol, it was suggested that butter should be replaced by plant sterol or plant stanol containing margarine to achieve and intake 2 g of plant sterols or stanols per day.

  • Blood pressure 120/85 mmHg
  • LDL-cholesterol 101 mg/dl (2.62mmol/l); HDL cholesterol 48 mg/dl (1.24mmol/l).

The patient was reviewed again 3 months later. Through the combination of dietary changes including daily consumption of plant sterol or plant stanol and increased physical activity this patient successfully lost weight and improved his cardiovascular risk profile. The abnormal relaxation pattern of the left ventricle disappeared and the physical performance capacity of the patient significantly improved. Blood pressure was well controlled on treatment with Ramipril 10 mg daily. Vitamin D remains subnormal. LDL cholesterol decreased by 39 percent and is within the recommended target range, HDL cholesterol increased by 21 percent, triglycerides slightly improved. Drugs for lowering cholesterol have not been required.

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