Coronary Artery Dissection Malpractice Case Settles for $2M
2015 Medical Malpractice Trial Report
Delay in diagnosis of coronary artery dissection results in the death of a 38-year-old man
The plaintiff’s decedent suffered a premature and preventable death from coronary artery dissections on 2/2/09 at the age of 38.
On 2/1/09 at 9:30 p.m., the patient presented to a community hospital with complaints of constant chest pain, nausea, shortness of breath and weakness. An EKG revealed an acute inferior wall myocardial infarction. The patient received Metoprolol, Nitroglycerin, Dilaudid, Ativan, Plavix, and Heparin. He was transferred to a tertiary care center for an emergent cardiac catheterization.
He arrived at 10:50 p.m. and was immediately taken to the cardiac catheterization lab. The cardiac catheterization, performed by the interventional cardiologist defendant revealed normal coronary arteries with no evidence of thrombus. During the cardiac catheterization, the patient was free of chest pain. The catheterization ended around 11:30 p.m.
Upon arrival to the floor at 12:00 a.m., the patient developed chest pain similar to his prior pain. The cardiology fellow defendant ordered Diltiazem and Nitroglycerine at 12:15 a.m. and morphine at 12:30 a.m. which did not relive the chest pain. At 12:41 a.m., he was given Dilaudid and at 12:57 a.m. he was given Diltiazem. The fellow’s assessment was that the symptoms were likely related to coronary vasospasms.
A repeat EKG performed at 1:08 a.m. revealed sinus rhythm with an acute inferior wall myocardial infarction. The plan was to transfer the patient to the critical care unit for further care and heightened observation. At 1:25 a.m., right before transfer to the CCU, he went into ventricular fibrillation and coded. He was brought back down to the catheterization lab but remained unresponsive and died.
On autopsy, the cause of death was determined to be dissection of the coronary arteries leading to cardiac ischemia and arrhythmia. Dissections without thrombus were found in both the right coronary artery and in the obtuse marginal branch of the left circumflex artery. The pathologist noted that as the dissections were not seen at the cardiac catheterization, they must have occurred in the span between the catheterization and the death.
The plaintiff claimed that the defendants were negligent when they failed to order and/or perform continuous 12-lead EKG monitoring or frequent interval EKG’s, recognize and appreciate that the patient was not suffering from vasospasm when his chest pain did not resolve with medications, and diagnose the coronary artery dissection.
The defendants contended there was no reason to suspect a dissection, and since the coronary arteries were proven to be patent by catheterization, it was appropriate to suspect and treat the patient for a vasospasm. Moreover, even if they had suspected a dissection and returned the patient to the catheterization lab, the dissections were in places that were not capable of being treated in the catheterization lab.
The parties agreed to arbitrate the case with a high-low agreement. While the arbitrator’s decision was pending, the case was settled for $2,000,000.
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