A patient with a history of valvuloplasty to treat teenage aortic stenosis suffered complications thirty years later, ultimately passing away due to an allegedly neglected heart condition. Though the valvuloplasty had been completed without difficulty at the time, the patient began to experience shortness of breath decades later, and doctors decided she needed a Bentall procedure to graft on an aortic valve replacement. During her hospital stay, doctors noticed that the patient had fluid buildup in both her lungs and in the pericardial membrane around her heart, but decided it was not severe enough for treatment. After her discharge from the hospital, the patient began to vomit, causing her doctors to suspect she was experiencing a septic bacterial infection. Though the cardiologist adamantly recommended an echocardiogram to assess the patient’s heart, it was never performed. This proved to be critical; the patient’s heart quickly fell out of rhythm, her blood pressure lowered, and she became agitated. She was given an anti-anxiety medication, and quickly went into heart failure. An emergency echocardiogram revealed that her heart had become compressed due to the collection of fluid in the surrounding membrane, and she eventually passed away from cardiac tamponade. It was alleged that a proper standard of care had not been met, and an expert in cardiology was asked to opine on the case.
Question(s) For Expert Witness
1. What is the standard of care for the attending surgeon if a patient is admitted with sepsis versus pericardial effusion?
2. What can be used to diagnose cardiac tamponade if Echo is not available?
Expert Witness Response E-034657
Our practice does approximately seven Bentall procedures every year. In this case, the standard of care is to attempt to rule out any immediately life-threatening causes of symptoms. If it’s the doctor’s patient, it’s the doctor’s responsibility. Cardiac tamponade is primarily a clinical or physiological diagnosis, and the physical findings plus a CT scan should lead to a high level of suspicion that the heart has become compressed. Though an Echocardiogram is the fastest and least invasive way to diagnose cardiac tamponade, a diagnosis can also be achieved through catheterization or an MRI scan.
About the author
