Chest, pain angina, heart attack diagnosis and medical malpracticePrompt diagnosis, testing, monitoring, and intervention are important
Of all the things that can happen to us medically or health-wise, I bet the importance of chest pain is top of mind for most people.
A particular type of chest pain that concerns physicians is angina. Angina is a classic symptom of coronary artery disease (CAD). Many patients with angina describe the chest pain as pressure, heaviness, tightness, or squeezing sensation in the chest.
The American Heart Association (AHA) explains that the current understanding of chest pain requires an expansive definition. It’s more than just pain of the chest. It includes pain, pressure, tightness, or discomfort of the chest, shoulders, arms, neck, back, upper abdomen, and even jaw, plus shortness of breath and fatigue. The AHA recommends that doctors and clinicians consider all of these symptoms as equivalent to angina.
From scouring through the medical records in many medical malpractice cases that we’ve handled in Texas, it seems that when a patient shows up in a hospital emergency room (ER) complaining of chest pain, the nurses and physicians typically jump right on it. And that results in a quick physician order for cardiac enzyme tests.
A cardiac enzyme test involves taking a blood sample and sending it to the laboratory for analysis. The lab looks for different levels of cardiac enzymes in the blood. Abnormally high levels can be an indication of a heart attack (myocardial infarction) or another serious heart problem.
One of the most important cardiac enzymes analyzed is troponin. Under current AHA guidelines, high-sensitivity cardiac troponins are the preferred laboratory test to make the diagnosis of myocardial infarction.
Troponin is a type of protein that’s found in heart muscle. It’s not normally found in the bloodstream unless there is damage to the heart, which causes it to be released.
According to the Cleveland Clinic, the normal ranges for troponin are:
• Troponin I (the kind unique to heart muscle): 0–0.4 ng/mL
• Troponin T: 0–0.01 ng/mL
Troponin levels increase dramatically within 3–12 hours after a heart attack before topping out around 24 hours after the heart attack. After that point, troponin levels will remain elevated for a week or two.
Cardiology experts have described the standard of care requiring serial (repeated) troponin tests in patients being worked up for a heart attack to see how the numbers trend.
The AHA recommends that patients with acute (new) chest pain call 911 and get to a hospital for evaluation quickly. This is even though after workup it’ll turn out that most patients won’t have a cardiac cause for their chest pain. The guidelines just emphasize the importance of identifying those people who need urgent intervention.
Once chest pain patients make it to the hospital, it’s up to the physicians and nurses not to drop the ball. We’ve handled cases where the patient did the right thing and got to the ER fast, only to have their care bungled. In one case—we’ll call the patient Sydney—repeat troponin tests showed higher and higher numbers and his chest pain wouldn’t go away even after morphine and nitroglycerine.
Sydney’s hospitalist and cardiologist physicians didn’t review the record or ask the right questions, and the nurses kept them in the dark by not notifying them of important findings.
In Sydney’s case and other like it, medical malpractice can lead to serious injuries or, as in Sydney’s case, needless and avoidable death.
To avoid these types of medical and nursing errors, the AHA recommends protocols or clinical decision pathways to guide ER personnel through the diagnosis and treatment process. Under the protocols, some patients diagnosed with a heart attack will need an emergency trip to the cardiac catheterization (cath) laboratory. Depending on their symptoms and lab work, others may be able to wait until the next day, under continuous telemetry (heart) monitoring, with thorough nursing observation and robust communication with the medical team.
If you’ve been seriously injured because of poor heart or cardiac care in Texas, contact a top-rated, experienced Texas medical malpractice lawyer for a free strategy session 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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