Patient Dies After Being Discharged With Congestive Heart Failure

This case involves a 52-year-old female patient with a past medical history of untreated hypertension. The patient was rushed to the hospital after experiencing a severe episode of shortness of breath while shopping at a local convenience store. The patient also complained of a chronic cough with sputum production for the past month. A chest x-ray revealed fluid in the right lower lung and an EKG revealed Left Ventricular Hypertrophy and non-specific ST-T changes. The patient was admitted under the care of a cardiologist and taken for a cardiac catheterization. The procedure revealed normal coronary arteries and nonischemic cardiomyopathy with an ejection fraction of about 30%. The patient was started on anti hypertensive medication and discharged the next day with orders to maintain a low salt diet. Approximately 2 hours after her discharge, she had an abrupt onset of shortness of breath while climbing stairs and she collapsed on the floor. She was transported back to the emergency room unresponsive and in sinus tachycardia which progressed to Pulseless Electrical Activity PEA. The patient remained on a respirator for this point on until she passed away, approximately a year and a half later. The cause of death as cited on the death certificate was cardio-pulmonary arrest secondary to coronary artery disease, sepsis, and respiratory failure.

Question(s) For Expert Witness

1. Should the patient have been discharged with a EF of 30?

Expert Witness Response E-000651

It is not normal to discharge a patient with an EF of 30 %, but it does happen. It really depends on what type of medication the patient was given as well as other mitigating factors. Also, the impending cardiac arrest should have been noted before the discharge. It seems that all aspects of the care provided here were below standard.