Failure to Diagnose and Treat Heart Attacks and Other Medical Emergencies

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Failure to Diagnose Heart Attacks.
For many of us, there is nothing more frightening than a trip to the emergency room. Just making the decision to go often means the patient is frightened and fears something is seriously wrong. Most of the time, the physicians and nurses working in emergency rooms do an excellent job of diagnosing and treating the patient. Making the correct diagnosis when the problem is possibly life-threatening and beginning treatment promptly is the true focus of an emergency room. The physicians and nurses staffing emergency rooms need to be aware of the signs and symptoms of life-threatening situations and be prepared to skillfully and appropriately treat the problem.

Unfortunately, this isn't always the case. Hurried, overworked physicians sometimes don't carefully listen to a patient's complaint; sometimes they simply make a mistake in their assessment of the situation. Sometimes the patient may not provide enough information. The failure to diagnosis a heart attack, aneurysm, or other life-threatening problem can be devastating to the patient and family.

What is a heart attack?
A heart attack or myocardial infarction (“MI’) occurs when the blood supply to part of the heart muscle itself is severely reduced or stopped. The reduction or stoppage happens when one or more of the coronary arteries supplying blood to the heart muscle is blocked. Deposits of cholesterol and other fat-like substances can build up in the inner lining of these blood vessels and become coated with scar tissue, forming a thickening in the blood vessel wall known as plaque. When plaque and fatty matter narrow the inside of an artery to a point where it cannot supply enough oxygen-rich blood to the heart, cramping of the muscle occurs. This is called ischemia. Prolonged ischemia can cause the death of cardiac cells (necrosis). This can kill or disable someone, depending on how much heart muscle is affected.

How prevalent is heart disease in the United States?
According to the American Heart Association’s latest report, “Heart Disease and Stroke Statistics ---2005 Update,” heart disease remains America's leading cause of death, killing one American every 34 seconds, or more than 2,500 people per day. The report shows that in 2002, more than 927,000 Americans died from heart disease-related conditions, such as heart attack, high blood pressure, stroke, heart failure, and congenital heart defects.

More than 70 million Americans have heart disease, including 27 million people aged 65 or older. That number is expected to skyrocket as the nation ages. The American Heart Association predicts that by the year 2010, heart disease will affect 40 million Americans aged 65 and older.

What are the signs and symptoms of a heart attack (myocardial infarction)?
Some heart attacks are sudden and intense where no one questions what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often, people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can indicate a heart attack is happening:

  • Chest, abdominal, neck, back, arm, wrist or jaw discomfort (pain, squeezing, burning or pressure) with exertion or at rest
  • Excessive anxiety, sense of impending doom.
  • Pain or discomfort may begin in the central or left chest and then radiate to the arm, jaw, back or shoulder.
  • Pain or discomfort is usually not sharp or highly localized.
  • May be associated with shortness of breath or difficulty breathing, excessive sweating, loss of balance, nausea, vomiting or light-headedness.
  • Can develop in the abdominal region (often confused with indigestion or heartburn), arm, shoulder, wrist, jaw or back, without occurring in the chest, although this pattern is atypical.
  • Not affected by moving the muscles of the region where the discomfort is localized, nor is it worsened by deep breathing.
  • The discomfort is not positional in nature.
  • About 1/3 of all heart attack patients do not have chest pain at all, putting them at a much higher risk of misdiagnosis.
  • Prior to a heart attack, women are more likely than men to be nauseous and experience pain high in the abdomen or chest. Their first symptoms may be extreme fatigue after physical activity rather than chest pain.
  • Symptoms such as blackouts, fainting or breathing difficulty may also be a sign especially in diabetics. Diabetics do not have the same nerve pain impulses as non-diabetics and can suffer ischemia without any chest pain at all.

What would be considered “malpractice” in failure to diagnose a heart attack case?
In an emergency room, a heart attack can be misdiagnosed as heartburn, indigestion or some other ailment. Every situation needs to be analyzed under its own facts and circumstances but other procedures etc are changing what would or would not be acceptable medical conduct. The backbone of good medical assessment and treatment still begins with a good but initially brief history and physical examination of the patient. The history should focus on risk factors for heart disease (family history, previous heart conditions, drug interactions, patient alcohol or drug use, smoking, etc.) and the main complaint bringing the patient to the hospital or urgent care.

It is no longer acceptable practice for a physician to determine that the patient with chest pain is not having a heart attack at that moment and then send the patient home. Even a small amount of ischemia puts a patient at risk. Symptoms should be investigated using the myriad of diagnostic and therapeutic tools available, even in hundreds of small community hospitals.

New guidelines, policies and procedures are changing the way patients with chest pain are evaluated and treated. These advances can prevent misdiagnoses, which may lead to unnecessary procedures, expensive medical bills, loss of wages, and lost time spent away from loved ones. In some cases, failure to diagnose a heart attack may even lead to death.

If you or a loved one has suffered an injury or death following a failure to diagnose a heart attack, aortic aneurysm dissection or other medical condition, perhaps we can help. Please call our medical malpractice lawyers at 1.800.553.9910. You can also send us an e-mail by clicking on this link: contact us.

Alpert and Thygesen, et. al., Myocardial Infarction Redefined JACC Vol. 36, No. 3, September 2000:959-69.

Braunwald et. al. ACC/AGA Practice Guidelines. Circulation 2000;102:1193-1209.

Eisberg, John F., ZaiKaner Miller, Phyllis, Failure to Diagnose Acute Coronary Syndromes (ACS), American Trial Lawyer Association 2001 Summer Presentation.

Weber M., Strauss McErlean E., Cardiovascular Surgery, Critical Care Nurse Vol. 20, No.4, August 2000; 78-91.

Ryan T.J., Anderson JL, Antman EM, Braniff BA, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel BJ, Russell RO, Smith EE III, Weaver WD.ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1996;28:1328 –1428.



(American Heart Association “Heart Disease and Stroke Statistics---2011 Update)

Robins Kaplan LLP a leading  medical malpractice law firm, has the experience and resources to take on important and challenging failure to diagnose heart attack cases.  If you would like a free consultation please call our lawyers at 1.800.553.9910.  You can also send us an e-mail by clicking on this link: contact us.