The failure to diagnose and treat a heart attack can lead to catastrophic injury or death. Despite the many advances and protocols established to promptly diagnose and treat heart attack patients, some patients are still sent home from the emergency room without the correct diagnosis and suffer a catastrophic heart attack soon after leaving the hospital.

 

Chest pain can be caused by many things other than a heart attack. Because a heart attack is the most prevalent and catastrophic condition associated with chest pain, doctors assessing chest pain patients are required to follow well-established protocols so that a heart attack can be promptly ruled in or out of the working diagnosis. The primary components of the protocol are:

 

• 12-lead EKG: When the chest pain patient arrives at the emergency room, an EKG will be done right away. If one or more of the patient's coronary arteries is completely blocked and shutting off oxygenated blood flow to the heart, the EKG will identify the blockage and the patient will be rushed to the catherization lab for an angiogram and stent placement or other intervention. A negative EKG does not mean that the patient did not have a heart attack before arriving at the hospital; it means only that none of the coronary arteries is completely blocked at the time of the EKG. Thus a negative EKG, by itself, cannot rule out a heart attack. 

 

• Nitroglycerin: When the chest pain patient arrives at the emergency room, nitroglycerin will be administered right away. If one or more coronary arteries is obstructed, this medication can help open up the obstructed arttery so that oxygenated blood flow can flow to the heart. This will reduce chest pain. If the EKG does not reveal that a coronary artery is completely blocked, the relief of chest pain from administration of nitroglycerin indicates that there is significant blockage in one or more coronary arteries and futher investigation is required.

 

• Troponin Levels:  When the chest pain patient arrives at the hospital, blood should be drawn right away to measure troponin levels. When heart tissue dies due to obstructed blood flow to the heart, troponin levels will rise. The troponin levels may not be elevated, however, for several hours after the heart attack, and so initial troponin levels may be negative if the heart attack occurred in only last few hours. This is why repeat troponin level are drawn hours later if the doctor is still trying to diagnose the cause of the chest pain.

 

If the EKG and troponin levels are negative for heart attack, and the nitroglyerin does not relieve the chest pain, the doctor should consider and rule in or rule out other conditions that are potentially catastrophic, including aortic dissection and pulmonary embolism. These conditons can be quickly and accurately diagnosed by CT scan, and once diagnosed, life-saving treatments can be effectively undertaken to treat the patient.

 

If you or a family member were sent home from the hospital after going there with chest pain and then suffer a catastophic heart attack or other event shortly thereafter, contact Bill Maddix, your Minnesota medical malpractice lawyer, for a free consultation.