Diagnosis of heart attacks in the Emergency Room has been made easier by a study recently published by the American College of Emergency Physicians (ACEP). The study recommends following an algorithm to rule in or rule out a heart attack within one hour of a patient arriving at the ER with symptoms or signs that may be due to a heart attack.
A heart attack might also be called a myocardial infarction or MI. Myocardial infraction refers to the fact that a blockage in the arteries that deprives blood and oxygen to the heart can result in death (infarction) of heart tissue (myocardium). Blockages can occur as a result of arteriosclerotic plaque or a blood clot. Symptoms of the blockage include chest pain, back pain, shortness of breath, sweating, nausea and related symptoms. If the blockage is diagnosed promptly, surgery can be performed to open the blocked artery and restore blood flow to the heart. A delayed diagnosis of the blockage can lead to extensive damage to the heart and potentially death or being a so-called “cardiac cripple.”
The ACEP algorithm requires an emergent assessment after triage that includes history, physical exam, EKG, pulse oximetry, chest x-ray and blood work. The blood work should include a very sensitive test for troponin levels, which tend to be elevated in patients suffering an MI. Additional tests for troponin levels are to follow the initial evaluation. Using the algorithm, researchers “found that accurate rule-out and rule-in seems to be feasible much more rapidly than suggested in current American Heart Association/American College of Cardiology guidelines in the majority of patients.”
Under Ohio law, an ER doctor or cardiologist can be liable for injury or wrongful death when the diagnosis of MI is unnecessarily delayed. A delayed diagnosis may occur for various reasons. As medical attorneys practicing across the State of Ohio, we have handled cases involving delays occurring due to a receptionist failing to alert a doctor about a patient in the waiting room with chest pain, an ER physician’s failure to promptly review lab results, and ER personnel ignoring atypical signs of heart attacks such as back pain.
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