The starting point for evaluating medical malpractice claims in Ohio arising out of the diagnosis and treatment of valvular heart disease (VHD) is the 2014 Report of the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Management of Patients with Valvular Heart Disease as published in the journal Circulation. Valvular heart disease involves damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary.
Because symptoms from VHD can develop slowly or be present from birth, patients can be unaware of the symptoms. So, the starting point for treatment is detection. Recognition begins with screening at birth and thorough physical evaluation of other patients. Electrocardiogram (ECG), echocardiogram (TEE) and chest x-rays provide important information about the severity of the disease.
Because treatment of VHD depends on its severity, the new guidelines provide a comprehensive classification system that follows this format:
- Stage A: people with risk factors for VHD;
- Stage B: people with no symptoms but progressive, mild-to-moderate VHD;
- Stage C: people with no symptoms but severe VHD; and
- Stage D: people with severe VHD who have developed symptoms.
Medical malpractice claims may arise by failure to screen patients, failure to recognize signs and symptoms of VHD, failure to treat patients based on the foregoing classifications and associated treatment recommendations, and performing unnecessary surgery that results in a complication. Symptoms of VHD may include: shortness of breath, wheezing with physical exertion, swelling (edema) of the feet, ankles, hands or abdomen, palpitations, chest pain, fatigue, dizziness and fainting.
Treatment options depend upon the severity and type of VHD. In the case of bacterial endocarditis, antibiotics alone may prevent or resolve the problem. Other medications include anticoagulants in patients who have experienced a transient ischemic attack (TIA or mini-stroke). Balloon angioplasty and valve repair or replacement surgery may also be necessary.