Cardiologist Expert Witness Discusses Mismanagement of Multiple Cardiovascular Abnormalities

This case involves an eighty-one-year-old male who passed away due to cardiovascular disease. His autopsy report stated that the cause of death was due to arteriosclerotic cardiovascular disease, aortic disease, and mitral valve disease. Months prior to his death, he visited his cardiologist for an echocardiogram. It revealed thickened calcification deposits on the aortic valve leaflets and aortic insufficiency. Physical exam also showed the patient to be presyncopal and dyslipidemic, with bilateral carotid bruits. The patient was not prescribed cardiovascular medications or anti-cholesterol medications to slow the progression of the disease.

Question(s) For Expert Witness

1. What is the proper management of an individual with CAD?

Expert Witness Response

Beta-blockers are preferred for initial treatment of symptoms. Calcium channel blockers and nitrates are used routinely to relieve symptoms when initial treatment with beta-blockers is not successful or if beta-blockers are contraindicated or cause side effects. Ranolazine has been used successfully to improve anginal symptoms in patients who have not been successfully treated with nitrates, beta-blockers, or calcium channel blockers. Cholesterol lowering agents should also be administered if LDL levels are elevated. Regular exercise may reduce anginal symptoms.