Myocardial Infarction (‘heart attack’ and ‘acute coronary syndrome’)
A myocardial infarction (‘MI’) occurs when blood flow decreases or stops to the heart, causing irreversible death of the heart muscle. It occurs when there is a blockage of one of the three arteries which supply the heart with oxygenated blood.
The Australian Heart Foundation estimates over 400,000 Australians have had a heart attack at some time in their lives. Each year, around 54,000 Australians suffer a heart attack and there is one heart attack every 10 minutes.
Prompt and proper treatment by medical professionals is essential for getting the best possible outcome. Unfortunately, this is not always the case.
I have acted for many people (or their families) after suffering an MI and who have either been left with significant permanent impairment or died as the result of failure on the part of their doctors and hospital. Shortcomings in clinical practice include failure to recognise the symptoms of an MI, to conduct proper diagnostic tests such as ECG and blood gas to determine troponin levels (a protein released when MI occurs), or to properly evaluate the diagnostic results which should have led to treatment in a catheterisation laboratory.
Here are four examples of our medical negligence cases in this area (all the names have been changed)
Jane had a history of coronary artery disease and a prior MI which had involved having a stent (a small mesh tube that’s used to treat narrow or weak arteries) placed in her left anterior descending artery (LAD).
Her anti-platelet/anti-clotting medications she was required to take, were stopped 7 days prior to a gynaecological operation so that her bleeding could be controlled.
After the operation, she complained about pain in the chest to the nurses and staff.
They ignored the obvious history, and although she became extremely ill she was not seen by a cardiologist for some 18 hours after the onset of pain.
She was taken to the catheterisation laboratory (cath lab) where it was found that the previous stent had become blocked.
Jane survived although her heart suffered major cell death and she was left with significant physical impairment.
She could not live anything like a normal life and her life expectancy was cut short by decades.
Had Jane’s symptoms been properly investigated when she first complained to medical staff the further debilitating damage to her heart muscle would have been avoided.
Jane came to me for help and ultimately settled her dispute at mediation with the hospital.
A family night out was disrupted when Bill suffered shoulder and arm pain.
He went to the Emergency Department (ED) of the major tertiary hospital in town.
Bill was designated as potentially an Acute Coronary Syndrome (ACS) patient and transferred to the coronary ward.
His wife and children went home reassured that Bill would be monitored carefully overnight.
Unbeknown to them, a miscommunication between the ED and the ward saw Bill’s status as ACS removed and he was not monitored as he should have been.
Bill died that night in hospital.
If Bill had been monitored as ACS the blood gas results would have showed rising troponin levels and he would have been taken to the cath lab and his blocked arteries stented.
The Law Office of Conrad Curry supported Bill’s wife in suing the hospital for the mental harm caused to her and for the loss of financial and domestic support from her husband.
The Hospital settled the case at Mediation for several hundred thousand dollars.
Louise had been treated for coronary artery disease over many years.
She was recommended a non-essential gynaecological procedure.
Undecided, she sought the advice of her cardiologist who approved the withdrawal of her anti- platelet/anti-clotting medication so that she could undertake the operation.
After the procedure, she suffered a stenosis (narrowing) of the LAD.
Her cardiologist was called and an ECG conducted and blood gases taken. Troponin levels were high and rising and the ECG consistent with STEMI.
She should then have been taken to the cath laboratory.
She was not and consequently suffered considerable damage to the heart muscle making her ineligible to have further bypass surgery which would have prolonged her life.
Louise now has little quality of life and can no longer work.
She needs the support of her husband in all activities of daily living and her life expectancy has been reduced to just a few years.
The case is ongoing.
Myocardial Infarction (‘MI’) or heart attack is the irreversible death of the heart muscle caused by the prolonged lack of oxygen (‘Ischemia’). This arises as the result of a blockage of one of the three arteries which supply the heart with oxygenated blood.
Symptoms of MI include shortness of breath, fatigue, chest discomfort and sometimes epigastric issues such as a feeling of indigestion, fullness or gas. Typically, chest pain will be sub-sternal and may radiate to tech shoulder and down the left arm. From the perspective of vital signs there may be an increased heart rate, irregular plus, raised blood pressure, high respiratory rate and coughing or wheezing.
The ECG is the most important tool in initial evaluation in Acute Coronary Syndrome (‘ACS’). However, it is not entirely effective especially where the MI is a Non STEMI as opposed to STEMI. The most reliable marker is the troponin levels on blood gas. Troponin is the protein which is released when MI occurs. .
Where there is STEMI it is reasonable and appropriate clinical practise to ensure that the patient is treated with aspirin and nitroglycerin and ECG telemetry is employed. The patient may also require emergency coronary angiography in a catheterisation laboratory. Coronary angiography involves the insertion of a catheter into the vascular system which is treated through the arteries to the heart and the injection of non-contrast dye to diagnose blockage or stenosis. Often a blockage will occur as the result of the build up of atherosclerotic plaque. If detected physicians can conduct percutaneous coronary intervention (‘PCI’) of coronary angioplasty to insert a stent or carry out coronary bypass graft surgery which will allow blood to flow freely to the heart again. Even in cases where there is non-STEMI, it may be advisable to undergo angiography and PCI.
A catheterization laboratory or cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found.
Many hospitals do not have catheterisation laboratories. NSW Health Policy requires thrombolysis – clot busting treatment in those cases.