Lack of Monitoring Results in Permanent Cardiac Injury

Case Overview

In this case, the plaintiff from Minnesota drove himself to the ER with complaints of pain brought on by physical activity. The emergency room doctor had administered a test which was indicative of insufficient blood flow to the heart. The treating physician then ordered a cardiac monitor, as well as additional tests. These initial tests appeared to be normal. The patient was placed on a heart monitor, however the monitor was disconnected for some period of time during the patient’s admission, despite continuous cardiac monitoring being advised for his condition. Subsequent tests showed alarming findings, however the treating physician was not made aware of these findings. Another test revealed an acute heart attack. The patient ultimately survived, but was left with diminished cardiac function.

Questions to the Emergency Medicine expert and their responses

What is the normal work up for the complaints the patient in this case presented with?

The usual workup for a patient like this is an electrocardiogram upon arrival, complete blood count (CBC), metabolic panel, portable chest x-ray, IV access and placement on a telemetry monitor. Depending on the history, pain control is indicated, sometimes with nitroglycerine. If the first set of enzymes and electrocardiogram are normal, a second set is done 90 minutes to up to eight hours later, depending on local protocol.

What is the standard of care for a patient with suspected MI?

If an MI is suspected, the above work up is initiated, nitroglycerin is administered, unless otherwise contraindicated, and heparin or lovenox is administered. If there is a strong suspicion for acute MI, the cath lab team is called, then the cardiologist, for evaluation in the cath lab.

Could the outcome have been different had the patient's MI been diagnosed sooner?

As for outcome, if he presented with symptoms that were over four hours old, the outcome may not have been different. I would defer to a cardiologist as to any different outcome if the MI were diagnosed earlier.

About the expert

This multiple board certified physician earned his BS and MD from The Ohio State University and is a member of the American College of Emergency Physicians. He has held a number of directorships and professorships in the emergency medicine space, and is currently an attending physician and director of emergency medicine at a large hospital in Minnesota.