48 year old female with no prior history is hospitalized with a syncopal episode. Cardiac work-up occurs. Has a repeat episode, in patient, and found to have a 2nd degree AV block. An echocardiogram is performed. Interpreted and reported as normal. A pacemaker is implanted. Six weeks later, Patient collapses and dies. Autopsy rules out thrombus/infarct, PE, stroke. Autopsy does reveal left ventricular hypertrophy. I am looking for a cardiologist to review the echo. Preferably, one who routinely interprets echo's and is certified with the American Society of Echocardiography. Thank you.
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Do you believe there might have been medical error?
First, my background: I am board certified in cardiology and echocardiography, work in a major academic center, and run the Hypertrophic Cardiomyopathy program at my institution. I have probably interpreted between 30,000 - 40,000 echos during my career. This is what I do every day. The question is what - if anything - was missed. Need to see the images. If it was just mild left ventricular hypertrophy (LVH), probably unrelated. Was HCM missed? Again, need to see the images.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Again, the real answer is "possibly", Was this an arrhythmic death from something that a pacemaker would not treat, such as ventricular tachycardia/fibrillation? "LVH" in itself is not enough to say one way or ther other - need to see the pictures.
What makes you a good expert for this case?
Please see the above. I think I stated all of that.....
How often do you encounter cases similar to this one in your practice?
I read tons of echos. Therefore, I see a lot of everything....
Do you believe there might have been medical error?
Unless echo was grossly misinterpreted and had wall motion Abnormalities, decreased lv function I do not see relevance for its misinterpretation leading to death
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Again I don’t see how echo interpretation could lead to a bad outcome here
What makes you a good expert for this case?
I am a level 3 board certified echocardiographer, former lab director
How often do you encounter cases similar to this one in your practice?
Frequency would read these and would expect them to be normal
Do you believe there might have been medical error?
If the echo was read correctly and there indeed is no significant severe left ventricular hypertrophy then there would be no malpractice. The patient could’ve experienced sudden death for a variety of other reasons. If however the echocardiogram shows evidence of abnormal hypertrophy such as hypertrophic cardiomyopathy then there would be a case for malpractice
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If the pacemaker was working correctly the patient would not have died from a bradycardic arrest. That leaves a ventricular arrhythmia such as VTEC or V fib as a possible cause which evidently was not found on the autopsy. Occasionally severe hypertrophy including hypertrophic cardiomyopathy can lead to ventricular arrhythmias but evidently this was not discovered on the echo and not specifically mentioned in the autopsy
What makes you a good expert for this case?
Board-certified in medicine, Cardiology, interventional cardiology history of nuclear cardiology, read echoes although not board-certified in echocardiography. 42 years of experience and a professor of medicine and Cardiology at three academic institutions
How often do you encounter cases similar to this one in your practice?
In frequently cases of sudden death have better documentation and often have especially when autopsies performed a definitive diagnosis
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