Cardiology Medical Malpractice

Complications are frequent in the cardiac catheterization procedure, in which either a cardiologist or a radiologist performs the arteriogram studies. A plastic tube, is passed through a needle, usually into the groin (femoral) artery, up through the aorta, (the main artery of the abdomen and chest) and into the openings of the two coronary arteries of the heart. The radiologists use the same technique to do the arteriogram studies of the neck (carotid) arteries. As the catheter passes up the aorta, cholesterol deposits and blood clot debris, which are often found in the elderly, can break off. These follow the blood flow and often block the arteries to the legs.

The patient has to be told of that risk, and then the complication has to be followed up. The dislodging of that debris during the study is often unpreventable as it is a rather "blind" manipulative procedure.

If there is a blocked off blood vessel from embolization of this "debris", then a vascular surgeon is called. Plastic tubes called Fogarty embolectomy catheters, skinny tubes with a deflated balloon around the end are pushed through the clot, inflated and pulled back, removing the clots and debris, and often saving a leg if done timely. After eight hours of delay, irreversible changes will occur to the muscles and nerves. Not only will the clot become hard, but the side branches through which the blood would normally flow to the muscles of the leg become solidly blocked off. Even though the main artery is cleared out, these side branches remain blocked off and they won't open up to allow blood flow, so the main artery blood vessel has stagnant flow and will clot off again and again. Timely recognition of the complication and prior informed consent is important.

If the arteriogram operation is done through the arm, into the brachial artery, passing the catheter up to the heart area, that brachial artery can become blocked off (occluded) and if it does, timely operative intervention by a vascular surgeon is required. Complications are sometimes unpreventable, but the failure to treat the complications often is clear medical malpractice.

Cardiologists rarely misinterpret electrocardiograms (EKGs). Most often misinterpretation is on the part of general practitioners and emergency room physicians. The same is true of misdiagnosis or mistreatment of heart failure, which can be confused with asthma. Any new elderly "asthmatic" must have heart failure ruled out, as this can also cause wheezing and shortness of breath. The damages are usually limited to the suffering from the misdiagnosed condition; not to a permanent worsening of the heart muscle condition.

Misdiagnosis of a heart attack is most commonly an emergency room act of negligence and is discussed in that chapter. With the use of recently developed heart drugs (calcium channel blockers) some acute myocardial infarctions can be prevented. Worsening chest pain to the level of incapacitation at rest, increasing frequency, or resistance to Nitroglycerin would require timely institution of these medications. This therapy helps to overcome, to some degree, the “so what” defense to inadequate therapy for severe myocardial ischemia (crescendo angina).

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.

Misdiagnosis of a Heart Attack

A heart attack (myocardial infarction) is the most common cause of death in both men and women. Failure to timely treat will result in further irreversible heart damage with the consequence of heart failure, or worse: death. Classical crushing chest pain is most common in men, but not in women(who more commonly experience jaw, back or arm pain, or just fatigue).

Whenever any adult has symptoms of a heart attack, the following test must be performed: an electrocardiogram (EKG), plus blood enzyme test to rule out heart muscle injury (troponin and CPK). Even if these are initially normal, the patient should be monitored in a hospital for 24 hours, and retested, especially if they have high risk factors: a previous heart attack, high blood pressure, diabetes, high cholesterol (especially if their LDL {“lousy” cholesterol} is greater than 100), and if they have a family history of a heart attack. The failure to do this is a departure from the accepted standards of care.

Whenever a heart attack is diagnosed, the best treatment is to use blood clot dissolving medication (tPA: tissue plasminogen activator) within 4 hours to reopen the blocked coronary artery before irreversible heart muscle damage (necrosis: gangrene) occurs. Furthermore, continuous EKG monitoring will allow immediate treatment of any irregular heart rhythm (arrhythmias) before they cause ventricular fibrillation (just twitching of the heart muscle, without any blood pressure being created). Electrical defibrillation (electric shock to the heart) when immediately performed can often restart the heart, saving the patient’s life and brain before irreversible damage results.

If the patient sustained a heart attack and was negligently misdiagnosed, but did not die, the psychological damage can be extensive: heart muscle damage with some degree of heart failure: decreased cardiac pumping efficiency measured by a lower ejection fraction, plus higher risk for a fatal heart attack, and greater need for invasive procedures: angioplasty or coronary artery bypass graft (CABG), with their risks and expenses.

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.