Warning signs for fatal heart attack are missed

Early one morning in 2004, a married, 45-year-old mother of two woke up with excruciating pain in her right shoulder going into her arm.

The woman was seen at a local health center later that morning by a nurse practitioner and a doctor. The doctor’s notes from the examination indicated that the patient had pain on her right side going toward her upper back. The record further indicated that she had not experienced any trauma or performed any physical activity that would account for her pain.

The doctor diagnosed the woman with back and shoulder pain. She was sent home with a prescription for ibuprofen and told to apply ice or heat as tolerated. She went home and went to bed.

At approximately 6:00 p.m., her daughters and husband heard a loud noise from upstairs. They found the woman on the ground with her eyes closed. Her husband immediately began CPR.

Emergency personnel transported the woman to the emergency room. CPR and advanced cardiac life support protocols were attempted but were unsuccessful.

The cause of death is listed as asystole, ventricular fibrillation and coronary artery disease.

The family’s expert urgent care physician and cardiologist/internist were prepared to testify that the doctor who treated the woman was negligent in failing to take a proper and complete medical history, failing to thoroughly review her medical chart, failing to perform an EKG or order other cardiac diagnostic tests and failing to arrange for immediate transfer to an emergency department.

The experts opined that when the woman presented as a 45-year-old with back pain radiating into the shoulders, it should have suggested the possibility of acute myocardial infarction, cardiac ischemia or other cardiac disease.

The defense’s expert physician was prepared to testify that hemorrhaging around the pancreatic duct found in the autopsy indicated that the woman’s death was caused by acute pancreatitis precipitated by excessive consumption of alcohol, and that this condition precluded the administration of medications commonly used to treat acute myocardial infarction.

The expert also contended that the woman’s life expectancy was limited by her risk factors.

The case was settled for $700,000.

Type of action: Medical malpractice

Injuries alleged: Death

Date of settlement: Nov. 5, 2007

Submitted by: James E. Byrne, Thomas Drechsler and Jonathan E. Tobin, Byrne & Drechsler, Boston (for the plaintiff)