Doctors Fail to Diagnose and Treat Fatal Heart Attack

Joseph O'Neill

Written by
— Updated on October 10, 2017

Internal Medicine Expert WitnessThis case involves a female patient in her early thirties who presented to an urgent care center complaining of right sided shooting chest pain that began when she was working out a few hours prior to arriving at the urgent care center. She was given a standard workup and her EKG was reported as normal, however no cardiac enzymes were tested. She was discharged home with a diagnosis of heartburn. Hours later she presented a sudden cardiac arrest and died.

Question(s) For Expert Witness

  • 1. How often do you treat patients like the one described?
  • 2. What is the workup required to rule out chest pain of cardiac etiology?

Expert Witness Response E-008510

I very regularly treat patients like the one described. The workup required to rule out chest pain of cardiac etiology include bloodwork and depending on the condition, chest x-ray, ECHO, and other tests may be needed. The bloodwork includes the following: 1) cardiac biomarkers – troponins are the preferred test for the diagnosis of AMI. Creatine kinase MB (CK-MB) isoform levels rise too. 2) D – dimer – among patients with a low-pretest probability for pulmonary embolus (PE), a D-dimer test with high sensitivity can rule out the diagnosis, obviating the need for further testing. 3) Complete blood count – the white blood cell count may be elevated in any of the inflammatory or infectious etiologies of chest pain, such as myocarditis and pericarditis. 4) B-type natriuretic peptide (BNP) – when used in conjunction with other clinical information, natriuretic peptide concentrations can help to identify or exclude acute HF as the cause of dyspnea and chest pain. I teach my medical students and residents on a regular basis on this topic.

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