Failure to Diagnose Heart Attack in ER

The Armstead Case

This 41 year old married mother of two teenaged daughters went to a community hospital emergency room with complaints of chest pressure, throbbing pain in both wrists that radiated up her arms, a cough and what she thought were symptoms of a chest cold. (Medical Note: Many women show heart attack pain in their wrists and back while many men show heart attack pain in their chests and left arms) She had a complex history of heart disease, heart by-pass surgery, obesity and she was a smoker. An emergency room EKG was normal and cardiac enzymes were measured and were normal (Medical Note: cardiac enzymes sometimes indicate whether an active heart attack is present. This patient’s blood test was negative.)

Nitroglycerin, however, provided full relief from all of her complaints. (Medical Note: Nitroglycerin opens restricted blood vessels in the heart and is given to ease the pain of a heart attack. If the drug works it is one indicator that a heart attack is occurring.) After five hours in the emergency room, the patient was sent home with instructions to take additional Nitroglycerin if she had further chest pain and to see her regular cardiologist in the morning. The discharge diagnosis was angina (chest pain) of unknown origin. By the time the patient got home it was late at night. She tried to sleep but the pain would not go away. She used additional Nitroglycerin and sat up at her kitchen table all night waiting for morning when she could call her cardiologist’s office to schedule an appointment. She died at her kitchen table a short time after contacting her cardiologist’s office.

Had she lived a few hours longer her treatment would have been very different. The EKG was re-read by a hospital cardiologist as a matter of routine and he determined that the EKG taken in the emergency room did show an active heart attack.

The plaintiff’s experts stated that this patient should not have been discharged from the emergency room when she had a history of heart disease, Nitroglycerin relieved her chest and wrist pain and her EKG, which had been “grossly misread”, actually showed an acute (active) heart attack (Medical Note: Myocardial Infarction, or ischemic heart disease, which means dying heart tissue due to blocked blood vessels.)

The case settled one week before trial with one half of the distribution going to the client’s husband, one quarter going to her by-then 18 year old daughter and one quarter being deposited into court controlled investments on behalf of the younger daughter with periodic payments to be made spread out through her college years.