IMPORTANCE OF TIMELY DIAGNOSIS AND TREATMENT IN HEART ATTACK CASES
News article published on: 22nd May 2019
Every year in the United Kingdom there are over 200,000 hospital visits due to heart attacks, which equates to one visit every three minutes. However since the 1960s there has been a significant improvement in survival rates, with seven out of ten patients now surviving after suffering a heart attack, primarily due to improved medical treatment for heart attack patients. Despite this improvement, the United Kingdom still has lower survival rates than other advanced economies. For example, a recent study published in the British medical journal The Lancet found that death rates for UK patients following a heart attack were 30 percent higher than for Swedish patients (Sweden is a world leader in cardiac care).
A heart attack happens when one of the coronary arteries, which provide blood to the heart muscle enabling it to function, becomes blocked. This prevents oxygen being supplied to the heart muscle, and the result is that the muscle will begin to die. There are two main types of heart attack, the most serious of which is known as an ST segment elevation myocardial infarction (or STEMI), in which the interruption to the blood supply to the heart muscle is caused by a total blockage of the coronary artery. The other is known as a non-ST segment elevation myocardial infarction (NSTEMI), in which the blood supply to the heart muscle is partially as opposed to totally blocked. However, without urgent treatment NSTEMI can progress to STEMI.
The most common symptoms of a heart attack include pain or discomfort in the patient’s chest, which occurs suddenly. This pain may spread into the left or right arm and also to the neck, jaw, stomach and back. It is also very common for patients to feel nauseas, sweaty and to be short of breath.
As these symptoms are most commonly experienced suddenly and when the patient is at home or in a non-hospital environment, it is important to call an ambulance as soon as possible.
Early Diagnosis and Treatment is Key
In cases of acute myocardial infarction (AMIs), early diagnosis and urgent specialist treatment, followed by cardiac rehabilitation to reduce the probability of a recurrent heart attack or death, is essential. It is important to restore blood flow to the damaged heart muscle as soon as possible, and the restoration of this blood flow, in order to limit the amount of irreversible damage to the heart muscle, can be life-saving.
The most important diagnostic test for suspected heart attack patients is an electrocardiogram (ECG). An ECG test should be carried out within 10 minutes of the patient’s first medical contact, be that with an ambulance crew or at hospital, in accordance with NICE guidelines. The ECG test measures electrical activity within the heart and allows doctors to determine how well the heart is functioning. The ECG will help to determine the type of heart attack the patient has had, and therefore the most appropriate treatment path.
In addition, patients with suspected heart attack should have cardiac troponin measured in a peripheral blood sample taken at the time of their arrival to hospital, and should undergo serial troponin testing thereafter. Troponin is a protein which is released into the patient’s bloodstream during a heart attack and therefore elevated troponin levels help doctors diagnose a heart attack and provide the relevant treatment as early as possible.
The treatment options are dependent on whether the patient has suffered STEMI or NSTEMI. STEMI is the most serious form of heart attack and so treatment should commence as soon as possible after diagnosis. If symptoms commenced within the past 12 hours, the patient will normally undergo primary percutaneous coronary intervention (known as PCI).
Patients presenting with STEMI will be rapidly transported by ambulance to a PPCI cardiac centre, and will thereafter be taken to a catheter lab for emergency PCI with stenting to open the acutely closed artery (revascularisation). This has the effect of preventing further damage to the heart muscle but is only of value within the first 12 hours of a heart attack (but for maximum benefit, within the first 6 hours).
For patients presenting with NSTEMI (or unstable angina), blood thinning medication including aspirin is usually recommended. Even in these cases, coronary angioplasty or coronary artery bypass graft may be recommended after initial treatment with the above medication.
Consequences of Delay
As is mentioned above, the treatment of heart attacks in the United Kingdom and the consequent survival rates have improved in recent years. However, sometimes things can go wrong and treatment can be delayed, with life-altering consequences for the patient concerned.
Osbornes Law has recently acted in two cases where there was a delay in diagnosis and treatment of a heart attack.
In the first case, we were instructed by the widow of a 55 year old man, who had complained of chest pain one evening on his return from work. Our client had called 111. Our client’s husband was also complaining of right shoulder pain. The 111 operator advised an ambulance would be sent to our client’s home address. A Private Ambulance Service ambulance arrived and an ECG was performed, which was noted to be abnormal.
Despite this finding, the Emergency Medical Technician did not recommend our client’s husband be transferred to hospital. She persuaded him there was no need to attend hospital. Later that evening, our client’s husband continued to suffer from chest pains. In the early hours of the following morning, our client found her husband unresponsive and despite resuscitation attempts he was pronounced dead. Osbornes obtained expert evidence from a Consultant Cardiologist & Specialist in Interventional Cardiology, who concluded that it was a breach of duty to not transport our client’s husband to hospital by emergency ambulance on a primary PCI pathway, and that had this been done, our client’s husband would have had PCI treatment, recovered uneventfully and been continued on therapeutic and prognostic medical treatment.
Osbornes wrote a Letter of Claim to the Private Ambulance Service and an admission of liability was obtained. Following negotiations a six figure settlement was eventually agreed with the Defendant.
In the second case, we were instructed by a 42 year old Polish man who had attended the Accident and Emergency Department of his local hospital by ambulance complaining of shortness of breath and tightness in his chest. The latter symptom was thought not to be prominent, and a diagnosis of an asthma attack was made. Our client had complained of burning in his throat and a chest x-ray was undertaken which was suspicious of infection in the chest. An ECG was also carried out and the automated report suggested an abnormality of possible underlying heart attack. Despite this, the ECG’s were reported by the doctors as normal and our client was discharged home.
The following day our client again attended the Accident and Emergency Department at his local hospital. This time his ECGs were consistent with an acute STEMI and he was transferred to the nearest cardiac centre, where he underwent coronary angiography, primary PCI and a stent in his right coronary artery. The heart attack was described as late presentation.
Osbornes again obtained a report from a Consultant Cardiologist & Specialist in Interventional Cardiology, who was of the expert opinion that on our client’s first presentation to hospital, a cardiac cause of his symptoms should have been considered and investigated further. The expert concluded that the failure to consider and carry out a troponin test was a breach of duty, and that this changed our client’s course of treatment significantly. Had our client been admitted to hospital on his first presentation, he would have been started on appropriate treatment for an acute coronary syndrome, including Aspirin and Clopidogrel both as antiplatelet agents and blood thinners. Although our expert concluded that our client would have needed coronary intervention with stenting in either scenario, he said that on the balance of probabilities, our client would have sustained less in the way of damage to his heart muscle.
A Letter of Claim was sent to our client’s local hospital and an admission of breach of duty was obtained. However the hospital disputed the causation element of the case and said that our client would likely have suffered a degree of heart muscle damage in any event. Eventually, after negotiation with the hospital, a five figure compensation sum was obtained for our client.
We are acting for several other clients’ in connection with similar cases, as well as one involving a fatal outcome leaving a spouse and two young children. The deceased could and should have been treated in a timely fashion when first presented in A & E with cardiac problems and if so would still be alive today.
At Osbornes Law we care about how you are treated both by medical professionals at your GP surgery or at hospital and also under the care of private providers of health services. If you think that the care you or a loved one has received fell below the standard expected of a reasonably competent professional, then please do not hesitate to contact Partner and specialist medical negligence lawyer Stephanie Prior on 020 7681 8671. You can also fill in an online enquiry form.