Cardiologist Fails to Order Life-Saving Catheterization

This case takes place in Maryland and involves a female patient who was admitted to hospital with chief complaint of chest pain. She was seen by a cardiologist who noted that the patient had experienced one minor heart attack in the past, and that she continued to display chronic high blood pressure. EKG revealed no diagnostic changes, and additional tests also failed to uncover any signs of a possible heart attack. As a result of these reassuring findings, the patient was discharged without undergoing cardiac catheterization or any additional treatment. Shortly after being released from the hospital, the patient experienced sudden chest pain and became fell unconscious while at work. She was taken to the emergency room, where a thorough physical evaluation revealed massive blockage in multiple arteries. The patient died shortly after being admitted.

Question(s) For Expert Witness

1. Do you routinely treat patients like the one described in this case?

2. Have you ever had a patient develop this outcome?

3. Should this patient have undergone cardiac catheterization prior to discharge?

4. Have you ever reviewed a similar case in the past?

Expert Witness Response E-008919

I routinely treat these types of patients. I am a board certified interventional cardiologist. I am the director of the cardiac catheterization lab at my academic health center, and I treat patients with coronary disease daily. I have had patients present with chest pain who had normal stress tests and normal LV function who ended up with significant coronary disease. That said I have never had an outcome such as this. If the troponin level on this patient was considered negative (which it probably was), the stress test was negative, and the LV function was normal, most cardiologists would treat medically. Consideration could absolutely have been made for catheterization here, and it is likely that this patient would have had a superior outcome had that treatment been rendered sooner.