Thursday 1/27 - got out of bed overnight; not feeling well - family took her to ER; monitored
Friday 1/28 AM - they do tests and say she needs quadruple bypass
Transferred to cardiac center on other side of hospital for monitoring; plan was for bypass on Monday
Family visits that night; she is c/o pain in her chest like someone is jumping on her chest; Vietnamese; daughter is translating for her
Family asking for the doctor; nurses said they would call
Some PA nurses talked to ordered Nitro
Nitro helped for about 15 minutes
Nurses said we don't know where the cardiologist is
Nurses said they called for the doctor and said we can't get ahold of them
Midnight - family asked to leave
7 am Saturday - called; nurse says doing ok
9:30 am Saturday - called; nurse says not doing well; going into cath lab
Had sx - multiple stents
In room that afternoon - cardio surgeon and cardiologist
Cardio surgeon says I wasn't on call; my partner was
Cardiologist said "nobody called me; if I had known about her symptoms, I would've rushed her into surgery right away"
They said she started having a heart attack Friday night
Delay in tx after that
Left ventricle permanently damaged
Post sx, fluid backed into lungs, infection
Induced a coma, and then intubated
Thursday 2/2 - they said there's nothing else we can do; needs hospice; then doc asked if she had health ins; told him yes
In that case, let me call a different hospital and see if they'll take her; they agreed; air lifted to different hospital
Hospitalized all of Feb and March
Got a trach; was awake; was able to talk some
Never improved
Died 3/31 - DC shows cardiogenic shock - she had various complications during the hospitalization
Files:
Q: what was trend of cardiac biomarkers over course of first several days?
A: —
Q: Was there progression of ECG over the course of the weekend demonstrating worsening ischemia?
A: —
Do you believe there might have been medical error?
Delay in revascularization in the setting of an acute coronary syndrome.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Prolonged decision-making leading to loss of critical time, which may have led to permanent damage to the heart muscle (not treated within the stipulated time window).
What makes you a good expert for this case?
I am a practicing interventional cardiologist, with several years of experience. I am widely published and recognized as an expert in the field.
How often do you encounter cases similar to this one in your practice?
I encounter similar cases quite often.
Do you believe there might have been medical error?
depending on timeline and diagnostic details
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
depends on timeline and diagnostic details
What makes you a good expert for this case?
I am an experienced interventional cardiologist specializing in treatment of myocardial infarction
How often do you encounter cases similar to this one in your practice?
I treat similar patients weekly or more often
Do you believe there might have been medical error?
it appears that the patient underwent cardiac catheterization Friday 1/28. Depending on the severity of the anatomy and how the patients ventricle responded a case could have been made to push for urgent revascularization or if there was escalating chest pain consideration for IABP. In any case from limited data presented there appeared to be a delay in the response to this patients escalating symptoms that eventually resulted in CV shock and death. Timely revascularization or escalation in care with IABP if there was going to be a delay waiting for CABG.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Not all the data was provided but if there was clear escalation in symptoms than this patient with deterioration of LV function than a consideration for more urgent revascularization could be been made.
What makes you a good expert for this case?
I have been been practicing now 12 years in a large public teach academic hospital. I have an expert in CAD/MI.
How often do you encounter cases similar to this one in your practice?
This is a common case presentation. We often push for urgent revascularization. If CABG not possible then I take for emergent PCI.
Do you believe there might have been medical error?
Sounds like the patient had severe coromary disease needed revascularization, and then heated up decompensating and normally in that situation they would require either a temporizing measure, such as a balloon pump, or to go urgently to heart surgery or urgently get Stented , but clearly there seems to be a delay in care . The big piece to suggest that is that the cardiologist's comment insinuating that this wasn't handed in ideally manner . Perhaps a communication aspect. However, it really depends on what's documented and what exactly happened of course.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Potentially there is because the patient had a bad outcome, which was preceded by a delay in care which was somewhat confirmed by the providers
What makes you a good expert for this case?
I am an interventional cardiologist and have taken care of such patients multiple times, and I have seen this situation occur before, and I understand the nuances of this tupe of case
How often do you encounter cases similar to this one in your practice?
Pretty frequently patients who come in requiring inpatient urgent revascularization, such as this one occurs on a weekly basis. Much more rare would be someone who deteriorated into cardiogenuc shock while awaiting a procedure like this, but we will still see that several times a year.
Do you believe there might have been medical error?
Availability was problematic with either a problem with the physicians, the answering service, or the hospital. Discovery needs to be obtained.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Delay in treatment for acute coronary syndrome, is well known to increase mortality, and morbidity
What makes you a good expert for this case?
I am the author of clinical practice guidelines for the American College of cardiology and American Heart Association on heart attacks
How often do you encounter cases similar to this one in your practice?
Rarely is there a such an issue with availability. If the answer service can I get a hold of the physician, then the hospital and nursing staff must have an alternative plan to take care of the patient.
Want to open a case or submit response?
Comments are accepted only from Cardiology experts.