Failure to Diagnose Myocardial Infarction (Heart Attack, MI, Coronary Artery Disease)

Evaluate breaches in the standard of care in cases involving Failure to Diagnose Myocardial Infarction (Heart Attack, MI, Coronary Artery Disease)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Chest pain
    Symptoms of ‘angina equivalence’ such as chest discomfort / pain in the neck / shoulders / jaw / arms
    Breathing difficulty
    Giddiness / dizziness / loss of consciousness
    Weakness / fatigue
    Increased sweating
    Sounding heartbeat
    Nausea / vomiting
    Cool clammy skin
    Altered level of consciousness
    None of the above
    Answer unknown
    Why is this important?
    Symptoms of acute coronary syndrome include chest pain, referred pain, nausea, vomiting, dyspnea, diaphoresis, and light-headedness.
    (2012) 37 ECPCAR 7 237-310

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
Advanced age is considered the most significant risk factor for Coronary Artery Disease.

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  • Was a medical history obtained? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's examination, enables the clinician to make educated evaluations, and be better equipped to advise the patient.

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  • Was a physical examination performed? Why is this important?
    Answer this question
    
The 2013 ACCF/AHA Guideline for the Management of ST-elevation Myocardial Infarction and the 2012 ACCF/AHA Focused Update of the Guideline for the Management of Patients with Unstable Angina/Non–ST-elevation Myocardial Infarction include a brief but comprehensive history should be obtained to determine if there is any chest pain or discomfort, either intermittent or continuous for the last 12 hours, an Electrocardiography should be performed within 10 minutes after the patient arrives in the emergency department to look for ST-segment elevation or (presumed) new left bundle branch block (LBBB).

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  • Which of the following interventions were initiated?(Choose all that apply) Why is this important?
    Answer this question
    
All patients presenting to an emergency department with chest pain or other symptoms reflective of myocardial infarction should have an electrocardiogram (ECG) performed and interpreted immediately.

    (2000) 27 EPCCOP 3 631-649 



  • Was an electrocardiogram performed within the initial ten minutes of the patient’s arrival in the emergency department? Why is this important?
    Answer this question
    
Electrocardiography is the main diagnostic tool for verifying the presence of Acute Myocardial Infarction. Electrocardiography should be performed within 10 minutes after the patient arrives in the emergency department to look for ST-segment elevation or (presumed) new Left Bundle Branch Block (LBBB).

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  • Which of the following diagnostic laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    
The 2012 ESC/ACCF/AHA/World Health Federation Definition of Myocardial Infarction recommends the use of cardiac troponins T and I for the diagnosis of AMI overall and for each subcategory of AMI.

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  • Was the patient referred to a cardiologist? Why is this important?
    Answer this question
    
Once priorities and goals have been agreed on, referral to the appropriate professionals should be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized to enable all patients to achieve their maximum potential.

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  • What was the ECG interpretation? Why is this important?
    Answer this question
    
The ECG may be normal, abnormal with subtle findings, or grossly abnormal in the presence of acute myocardial infarction.

    (2000) 27 EPCCOP 3 631-649 



  • Which of the following diagnostic imaging studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    
Echocardiography is the use of ultrasonographic and Doppler techniques to create two-dimensional cardiac images, allowing assessment of blood flow velocity, valvular regurgitation, systolic and diastolic function, intra-cardiac pressures, cardiac chamber dimensions, and regional wall motion abnormalities.

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  • What was the result of cardiac biomarkers? Why is this important?
    Answer this question
    
Myocardial necrosis results in the release of cardiac biomarkers (CK-MB, troponin I or T) into the blood in both patients with STEMI -ST elevated myocardial infarction and patients with NSTEMI -non ST elevated myocardial infarction.

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  • With which of the following diagnosis was the patient assigned, treated for and released from the healthcare facility? (Choose all that apply) Why is this important?
    Answer this question
    
Misdiagnosis occurs frequently in patients who present withsymptoms of myocardial infarction.

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  • Was the patient discharged and later diagnosed with myocardial infarction? Why is this important?
    Answer this question
    
Some patients, particularly women, patients with diabetes, and elderly patients, may have atypical symptoms, such as nausea or worsening glucose control, whereas others may have no symptoms ('silent myocardial infarction'). A high level of suspicion is required in these patient groups. 

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  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    
Routine follow-up evaluations are necessary to offset any complications that may arise.

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  • What was the diagnosis given the patient? Why is this important?
    Answer this question
    
Acute myocardial infarction includes both ST elevated myocardial infarction and non ST elevated myocardial infarction.

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  • Was an informed consent obtained before administering anti-thrombotic / fibrinolytic agents? Why is this important?
    Answer this question
    
The laws of most states require that surgeons obtain informed consent before providing treatment.

    (2011) 23 EOMSCA 3 475-484 



  • Which of the following reperfusion medications were administered? Why is this important?
    Answer this question
    
Reperfusion therapy should be administered to all eligible patients with STEMI with symptom onset within the prior 12 hours. Primary Percutaneous Coronary Intervention, (PCI) is the recommended method of reperfusion when it can be performed in a timely fashion by experienced operators.

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  • Were reperfusion medications contra indicated? Why is this important?
    Answer this question
    
Evaluation of patients for thrombolytic therapy need to include additional history directed at contraindications to thrombolysis. These include: recent major surgery, recent cardiovascular accident and active bleeding. Relative contraindications include uncontrolled hypertension, recent cardiopulmonary resuscitation, and history of gastrointestinal bleeding.

    (2000) 27 EPCCOP 3 631-649 



  • Was thrombolysis / fibrinolysis initiated within 30 minutes of presentation to the clinician? Why is this important?
    Answer this question
    
Fibrinolysis should be initiated within 30 minutes once the patient has been seen by health care professionals.

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