Need to establish whether earlier treatment would have changed the outcome.
Timeline:
12/26/2024 - Family Medicine PCP visit (birth control follow-up). HR 124. Yaz started.
01/09/2025 10:49- Family Medicine PCP visit (URI/sinusitis symptoms). Z-pack given.HR 133. BMI 16.14.
01/13/2025 - Urgent Care / ED visit for chest pain and trouble breathing. Diagnosed with pneumonia, asthma.
01/16/2025 - Admission to UF Shands for severe heart failure / myocarditis vs dilated cardiomyopathy. HR 130's-150's. EF 19%. Positive for Coxsackie B3 & 4.
1/31/2025 - Heart transplant with ECMO decannulation and reconstruction at cannulation sites.
Files:
Q: Noting the heart rate was 124 on the initial visit that the patient complained of any symptoms or was an EKG done or was that at least noted in the Pcp chart?
A: —
Do you believe there might have been medical error?
The key in answering this is scrutiny of the 1/13 visit to the ER.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Should there have been deviation from standard of care during the 1/13 visit, then there is definite causality.
What makes you a good expert for this case?
My specialty is cardiogenic shock and use of mechanical circulatory support - like ECMO- for the sickest subgroup of patients.
How often do you encounter cases similar to this one in your practice?
On a daily basis as this is my specific specialty.
Do you believe there might have been medical error?
This young patient has had multiple visits with nonspecific symptoms, but progressive tachycardia. This should have alarmed the provider, to get cardiac studies, an EKG, and an echocardiogram. If these were done in a timely manner, there would be a possibility for recovery without transplantation.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Early diagnosis in this case may have changed the outcome drastically. If myocarditis was caught at the initial stage, targeted GDMT may have preserved the heart function, and treat the underlying disorder. The tachycardia with the symptoms should have caused concern for rapid and appropriate referral.
What makes you a good expert for this case?
I have been practicing for more than 2 decades in the field of cardiology and have a teaching position as well. My interest includes CHF, and myocarditis, and have treated countless cases of viral myocarditis with excellent outcomes.
How often do you encounter cases similar to this one in your practice?
I remember a 19 year old gentleman, with tachycardia and abnormal EKG with tachycardia who presented to our ER. Rapid diagnostic testing, and echo provided us the diagnosis. Medications were started right away. He left the hospital in a week with full recovery.
Do you believe there might have been medical error?
Not having all the details, the one thing that stands out is the patient clearly had significant tachycardia since the initial visit I want to forward it based on the timeline of when she presented with severe heart failure. She probably already was brewing a car him off at that time. Hence the tachycardia. Unclear if there was any symptoms reported or if the PCP noted the elevated heart rate in two separate visits or if an EKG was done. Would need more detail details, but it’s possible something was missed.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
It’s possible if the diagnosis was established earlier, it may have led down a earlyier intervention of medical therapy and a heart failure evaluation and possibly hospitalization and treatment with steroids if this was fulminant myocarditis. It’s also possible the outcome could have been the same hard to know without more details.
What makes you a good expert for this case?
Cardiologist and I’ve been practicing for over 13 years as an attending currently at an academic institutionand I take care of critical care patients in the coronary care unit and have had many myocarditis patients over the years
How often do you encounter cases similar to this one in your practice?
Probably once a year we will see a case of severe myocarditis like this either I’m directly involved or it’s at our institution and we have multidisciplinary meetings discussing it.
Do you believe there might have been medical error?
The heart rate should have triggered an ekg or further evaluation
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Earlier diagnosis might have meant earlier treatment and not transplant
What makes you a good expert for this case?
I’m an interventional cardiologist
How often do you encounter cases similar to this one in your practice?
It’s rare - twice in my ten years - but we’re early detections and treatment however.
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