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Texas man dies in hospital of NSTEMI heart attack, cardiac cath scheduled for next day

Nursing staff didn't keep cardiologist in the loop of patient's downturn

Almost everyone knows the symptoms of a heart attack.

The telltale symptom is chest pain or discomfort. Other symptoms include shortness of breath, feeling lightheaded, and pain or discomfort in the jaw, neck, back, arms, or shoulders.

What have we been told to do when we have those symptoms? Get to the hospital emergency room (ER) and do it fast.

That’s what happened to a man in his 50s. Let’s call him Caesar. We represent his family in a wrongful death medical malpractice case. That gives you an idea of where this tragic story is headed.

Caesar rushed to a Texas hospital ER after having chest pain that radiated to both of his arms. He described the pain as severe, 9/10. He had high blood pressure but wasn’t taking any medications.

The ER physician and nursing staff did a good job working up Caesar’s case.

• The emergency nurse noted that his blood pressure was very high.

• The doctor ordered lab work, including cardiac enzymes. The results showed that Caesar had an elevated troponin level. Troponin is a protein found in heart muscles. Troponin isn’t found in the blood unless heart muscle has been damaged. That’s why high levels of troponin are felt to be evidence of a heart attack.

• An EKG showed no ST elevation. An EKG, or electrocardiogram, is a study of the heart’s electrical function. An ST elevation is a particularly dangerous type of rhythm.

The ER doctor concluded that Caesar had experienced an NSTEMI, which is a non-ST elevation heart attack. He was admitted to an intermediate care unit (IMU) with telemetry (cardiac monitoring) under the care of a hospitalist.

The hospitalist ordered additional testing, including serial cardiac enzymes studies. Those showed that his troponin levels were trending upward. Our experts told us that this made it crystal clear that Caesar had an NSTEMI heart attack. The hospitalist also ordered nitroglycerin and morphine to help alleviate Caesar’s pain. He also ordered a cardiology consult.

The next morning around 10:00 a.m., a cardiologist saw Caesar. He validated the diagnosis of NSTEMI and documented a plan to take Caesar to the catheterization lab the next day. Cardiac catheterization, or cardiac cath, is a procedure done by an interventional cardiologist. It involves guiding a thin catheter through a blood vessel to the heart to investigate and treat some heart conditions.

When the cardiologist saw Caesar, he felt he was stable condition at that time to wait until the next day to perform the catheterization. Our medical experts because that this was a reasonable clinical decision.

Unfortunately, after the cardiologist’s assessment that morning, Caesar’s condition deteriorated. His pain level worsened and the nursing staff medicated him with morphine three times, in addition to nitroglycerin once. The nurses never notified the cardiologist, or any other doctor, of Caesar’s alarming pain level and clinical instability.

Our experts felt that if the cardiologist had known about Caesar’s concerning downward trend, then he would have likely expedited the catheterization to that same day. Unfortunately, Caesar was found unresponsive about 12 hours after the cardiologist saw him. He was pronounced dead about 30 minutes later.

Caesar’s autopsy showed that he had single vessel disease of the dreaded left anterior descending artery, which is called the widow maker. It was 90% blocked. Our experts believe that if Caesar had been catheterized that day, it would have revealed the blockage and led to ballooning, which would have restored blood flow and saved his life.

We believe this case shows the importance of good nursing communication. In this case, if the nursing staff did inform the cardiologist of the significant new clinical findings, Caesar would have received life-saving treatment. Caesar would’ve survived.

If you or someone you care for has been seriously injured because of poor cardiac or heart care in Texas, then contact a top-rated, experienced Texas medical malpractice attorney for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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