Doctors Fail to Diagnose and Treat Fatal Heart Attack

This 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.