Timely Cardiologist Care. In the ER, put your heart in the care of a cardiologist

Steven E. North, Esq.

There is no doubt that the damage from a heart attack can be significantly lessened, or in some cases avoided by prompt cardiac intervention. The failure of a physician to take the necessary steps in a timely manner is the basis of many medical malpractice cases. In fact, cardiology-based claims rank among the top three most common causes of medical malpractice claims.

A classic case of malpractice is an emergency room doctor failing to timely diagnose, or rule out a heart attack. Other cases include the failure to identify and deal with atrial fibrillation.

Atrial fibrillation is a disorder of heart rhythm: It is less commonly known by non-doctors than a “normal” heart attack caused by a blocked artery. But atrial fibrillations are not uncommon, and are frequently the source of valid malpractice claims (when treated poorly).

Atrial fibrillation is caused by ineffective muscular action of the upper portion of the heart. This impairs the flow of blood allowing it to stagnate and clot. Such clots may potentially proceed right to the brain, causing a stroke. Consequently, a prompt diagnosis of atrial fibrillation is essential because its dangers are so great, but if detected in a timely fashion, it can usually be effectively treated to avoid the worst consequences by giving blood thinning medications to prevent formation of dangerous clots.

Many drugs, Coumadin, Elequis, Truvada, Plavix for example, are effective in preventing clot formation in atrial fibrillation. Sometimes even plain aspirin will be highly effective. The anti-clotting prescription drugs, however, can produce side effects including bleeding and even serious hemorrhage in some circumstances, and must be carefully managed.

Failing to prescribe or prescribing doses of these drugs that are too high can lead to catastrophic results. And, if prescribing too little or too much medication was a preventable error resulting in significant harm, this may be the basis of a valid lawsuit.

Modern technology designed to determine whether a heart attack is in progress can be life saving. But the double-edged sword is that when physicians do not use the available technology or commit serious and preventable errors in its use, the patient may have basis for a significant case.

The modern electro cardiograph machine (ECG or EKG) is programmed not only to print out a tracing of cardiac function but also to provide a computer-generated interpretation of that tracing. Computers may be powerful assistants. But recent studies suggest that physicians can and too often do rely too much on the computer reading instead of going over the reading themselves. Dr. John Mandrola, author of the Medscape commentary on the subject, says that multiple studies have confirmed the unreliability of EKG computer readouts.

One can therefore infer that unless a skilled physician, hopefully a cardiologist, is called on to read an EKG tracing, particularly in the face of an acute event, there may be a foundation for a medical malpractice claim. Should a hospital not have a cardiologist onsite, it will most likely have cardiologists to whom EKG tracings can be sent electronically for immediate interpretation and discussion. There are often indicia on tracings that are beyond the capabilities of a computer or an emergency room physician to interpret, but which should be picked up by a cardiologist..

The implications of these studies go beyond lawsuits, and some situations may never become cases if individuals can help prevent harm from improper care. Our advice to patients: If you find yourself in an emergency room facing a real scare of a cardiac event, try to insist that the tracing be read by a cardiologist. Even if you’re told that a computer sees nothing wrong and an emergency room doctor has interpreted the tracing, be aware that this is often insufficient in terms of what an actual cardiologist might see.

We have prosecuted cases involving ECG computer tracings read as normal by an emergency room doctor but which were actually abnormal and led to serious consequences for the patient. If properly viewed by a cardiologist, such tracings may reflect sufficient irregularities to warrant medical attention, e.g., keeping the patient for at least some repeat EKG or blood studies to assess an elevation of heart attack markers in the blood, e.g., troponins, which suggest heart muscle damage.

The bottom line? Although computers have become a very reliable adjunct to our daily living, they cannot replace the skill of a trained cardiologist. If you or a loved one may be having a heart attack, don’t accept “everything is fine” from just a computer or even a well-meaning emergency room doctor. If life is at stake from a potential heart attack, the studies suggest that you should insist on seeing a cardiologist.