Case Archive
Ref. # 60528

An Alabama man underwent an electrophysiology study and deteriorated rapidly post-induction with ventricular tachycardia. Attempts to immediately deliver external cardioversion via the fast patch system were unsuccessful. It was replaced by chest paddles, which would not deliver an electrical discharge. CPR was initiated and the patient was intubated and bagged. A second defibrillator was brought and the patient converted to prolonged asystole with slow idioventricular response. After multiple attempts, the patient converted to sinus rhythm with marked prolongation of the PR interval. He subsequently expired. During CPR a Fluoroscopy documented accurate catheter placement; echocardiography ruled out effusion and perforation. A medQuest cardiologist with expertise in electrophysiology reported a very clear delay in cardioversion, a significant factor in the patient's death. There was no documentation regarding the cause of the machine failure. As mortality from electrophysiology studies should be 0%, there is potential liability on the part of the hospital and/or the manufacturer.

Ref. # 54728

A 66 year old Maine man presented to the ER, complaining of intermittent chest pain for 48 hours radiating down both arms. Throughout the morning of the patient's first day of hospitalization, the pain recurred and was resolved with oxygen via nasal cannula. Later that evening the patient complained repeatedly of extreme pain. The following morning the patient underwent a stress test, during which he experienced significant dyspnea. ST segment elevations in the anterior and lateral leads demonstrated a definite injury pattern. The patient required 12 days of hospitalization for myocardial infarction. A medQuest cardiologist reported that during the first evening of hospitalization the patient's symptoms were concurrent with MI or ischemia. Treatment with nitrates/heparin, thrombolytics or catheterization was not performed, as it should have been. The administering cardiologists were negligent in proceeding with the stress test, as the patient was ruled in for an MI. Timely and appropriate evaluation and treatment would have minimized the MI and the patient's subsequent suffering and hospitalization.

Ref. # 525001

A 70 year old Missouri man presented to the ER with complaints of chest pain for three days. He was scheduled for a stress test and told to call back. The next day he presented again to the ER with chest pain. An EKG was interpreted as showing minor abnormality with rest angina. Two hours after admittance he was seen for the first time by a physician, who diagnosed a myocardial infarction. The patient was started on telemetry in the room and blood gases were drawn. After 30 minutes his blood pressure had fallen 50 systolic points, which was not commented upon in the medical records. The patient went into cardiac arrest and could not be resuscitated. A medQuest interventional cardiologist reported the hospital staff negligently failed to make a rapid diagnosis of acute myocardial infarction, which was obvious by the patient's signs and symptoms, as well as on the EKG. Prompt administration of thrombolytic therapy or rapid referral for direct angioplasty saves the lives of 10% of similar patients treated. Furthermore, the failure to recognize cardiogenic shock prevented initiation of pressor and intra-aortic balloon pump support, which could also have saved the man's life.

Ref. # 51428

A 61 year old West Virginia woman presented to the ER with shortness of breath and chest discomfort and was discharged. She returned four days later with similar complaints and significant EKG changes, and was admitted to the CCU. Five days later she was transferred to another hospital for a heart catheterization. En route she developed marked shortness of breath, chest discomfort, pulmonary edema with EMD, and was resuscitated. She remained unstable and expired that day. A medQuest cardiologist opined that during the first ER visit the patient should have been admitted and worked up because of new EKG changes and significant symptomology. The hospital requested the second visit, during which the patient had continued pain that called for catheterization within two days. The misdiagnosis and delay in care constituted negligence. With appropriate diagnosis and treatment the patient would have survived, probably requiring surgery.

Ref. # 37328

A 61 year old West Virginia woman was taken to her family physician due to chest and stomach pain radiating to her back, shortness of breath, and vomiting. After an EKG, the family physician admitted the patient to a regional healthcare center for observation only. The patient was transferred from the ER to the ICU, where treatment consisted of Heparin lock and cardiac monitoring. She complained of shortness of breath and numbness in her fingers throughout the night. As a result of the patient's deteriorating condition, an EKG was performed late the next morning and was concurrent with a massive MI. Her symptoms continued for two hours, when a code was called. The patient expired one hour later due to cardiac arrest as a result of an acute, massive MI. A medQuest cardiologist opined that both the family physician and the managing physician at the hospital deviated from the standard of care. No cardiac consult was obtained despite clear evidence of cardiac disease. There was no treatment for unstable angina, MI, or pulmonary edema. With appropriate and timely catheterization and transfer to a major medical center, the patient probably would have survived.

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