Heart Attack Missed in Emergency Room Due to Psychiatric Profiling

This case involves a fifty-year-old patient who complained of sweating, vomiting, and arm pain, along with the other classic signs of heart attack, which prompted her to call 911. The patient claimed that the EHS staff was disdainful of her when they arrived, as they did not think her symptoms were serious. The patient stated that it took close to an hour for EMS staff to get her to the nearest emergency room (ER). Upon arrival at the ER, the EMS staff presented the patient as having psychiatric issues and her complaints of chest pain were not acknowledged until three hours after her arrival. After blood work was drawn, the lab reports showed markedly elevated cardiac enzyme levels and an EKG was ordered showing signs of a recent heart attack. The patient was in good overall health, but after her admission at the hospital, she required a pacemaker.

Question(s) For Expert Witness

1. If this patient was diagnosed with a myocardial infarction sooner, could the pacemaker have been avoided?

Expert Witness Response E-000320

This patient should have been worked up just like any other patient complaining of chest pain, no matter the patient's presumed psychiatric status. The goal for healthcare professionals is to diagnose in a very rapid manner whether the patient is having an STEMI or NSTEMI because therapy differs between the 2 types of myocardial infarction. Particular considerations and differences involve the urgency of therapy and degree of evidence regarding different pharmacological options. As a general rule, initial therapy for acute myocardial infarction is directed toward restoration of perfusion to salvage as much of the jeopardized myocardium as possible. This may be accomplished through medical or mechanical means, such as PCI or CABG. If such intervention was rapidly delivered, the pacemaker could have been avoided.