Physician Fails To Diagnose Early Heart Attack In Symptomatic Patient

Expert Cardiac Nurse Practitioner

This case involves a 52-year-old female patient with a history of high cholesterol and anxiety who presented with complaints of severe back pain. Although the defendant physician was aware of the patient’s symptoms and medical history, he did not perform a thorough cardiac workup or transfer the patient to the hospital for further investigation. The patient underwent an EKG, which was inconclusive and non-diagnostic for early heart attack. The defendant physician diagnosed the patient with a muscle spasm, gave her a prescription for muscle relaxers, and sent her home. Over the following weeks, the patient suffered several additional episodes of back and arm pain. Since she was told by the defendant physician that the pain was muscular, she took her muscle relaxers as prescribed and did not suspect that her pain had a cardiogenic source. One day while she was home, she lost consciousness. Despite CPR and advanced cardiac life support protocols, she remained in a cardiac arrest. The patient was transported to the hospital and pronounced dead on arrival. The cause of death was acute myocardial infarct. It was alleged that the defendant failed to provide a thorough cardiac workup and preventative care to the patient.

Question(s) For Expert Witness

  • 1. Please describe your experience treating patients suffering from severe back pain.
  • 2. Are you familiar with the proper steps in protocols that are typically followed when a patient presents with similar symptoms?

Expert Witness Response

I established and was part owner of a family practice clinic for 10 years. I currently teach in a doctoral level nurse practitioner program and teach cardiac modules and work-ups as part of both our acute and chronic patient care courses. Additionally, I work in a very busy emergency room and encounter patients with back pain multiple times in every shift. There can be many sources of back pain, with cardiac related back pain being the most significant. Ruling out cardiac causes is primary before moving on to ruling out other potential causes. I am very familiar with the proper protocols related to these symptoms, as well as current standards of practice.


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