Misdiagnosed chest pain leads to fatal MI
A 43-YEAR-OLD MAN, who smoked cigarettes and had a strong family history of coronary artery disease, had been under the care of a primary care physician for 3 years. The patient’s history also included at least 1 episode of chest pain.
The patient visited his physician complaining of intermittent chest pain for several days. He described 2 episodes of nausea, vomiting, and pain in his back teeth, followed by pain radiating down his right chest to the right costal margin. He had no symptoms during the office visit. The physician ordered an in-office EKG, which he interpreted as normal.
The physician diagnosed the chest pain as gastrointestinal in origin and prescribed an antacid. Because of the patient’s cardiac risk factors, the doctor scheduled a stress test and EKG for 2 days later.
On the morning of the stress test, the patient’s wife found him unresponsive. Resuscitation failed, and he was pronounced dead. An autopsy revealed severe proximal coronary artery disease of the left main coronary artery, left anterior descending coronary artery, and right coronary artery, as well as evidence of “remote and recent myocardial infarction.”
PLAINTIFF’S CLAIM: The EKG demonstrated significant changes compared with an EKG performed 3 years earlier and indicated that the patient was suffering an acute coronary episode. The doctor was negligent in failing to diagnose the episode and transfer the patient for proper cardiac care.
DOCTOR’S DEFENSE: The patient’s presentation indicated gastrointestinal distress; the EKG was normal.
VERDICT: $1.5 million Massachusetts settlement.
COMMENT: It’s imperative to compare EKGs, chest radiographs, and other tests with baseline results. How many times do you see an EKG that shows subtle but important changes that influence management?