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Heart Attack Misdiagnosis
Failing to recognize signs of cardiac ischemia (blockage of blood flow to the heart muscles) in the emergency room or doctor’s office can lead to a heart attack (myocardial infarction or death of heart muscle) which can be debilitating or fatal. Detecting signs of myocardial ischemia is a primary goal in all emergency departments, because heart disease is so prevalent in the United States and failing to diagnosis it leads to death. Errors can be made because of unusual presentations, misinterpretation of tests, inadequate history taking, and underestimating mild symptoms.
Not all patients present with typical signs of chest pain, shortness of breath, nausea and pain radiating down the left arm. Many patients, especially women and those with diabetes, may present without complaints of chest pain and have unusual and atypical symptoms such as shortness of breath, fatigue, common nausea or abdominal pain instead. Physicians need to have a high index of suspicion in these patients and not rely on the absence of chest pain to rule out myocardial ischemia. Attributing these atypical complaints to anxiety, gastrointestinal issues or musculoskeletal strains can lead to misdiagnosis and serious adverse outcomes.
Failing to take and properly interpret diagnostic tests that can identify developing cardiac ischemia allows progression to a complete heart attack. An electrocardiogram (ECG) is an important test for myocardial ischemia. However, failing to obtain and to properly interpret the ECG can cause a diagnosis of myocardial ischemia to be missed. While some ECG changes are specific for myocardial ischemia, there are nonspecific ECG changes that can be early signs of ischemia that can be easily overlooked. Troponin testing is a blood biomarker for myocardial injury that can confirm the presence or absence of heart muscle injury. CPK enzymes should also be tested, as they also can show the presence of myocardial injury. Failing to take a troponin test and CPK when there is suspicion of cardiac ischemia can lead to a missed diagnosis and permanent heart damage.
A detailed comprehensive medical history is important to elucidate symptoms of underlying cardiac disease and ischemia. Details about the type and character of any chest pain and associated symptoms such as shortness of breath, fatigue, diaphoresis and nausea are important. Whether the pain or discomfort worsens with exertion is another important factor. Ischemic cardiac pain usually increases with exertion and generally decreases with rest. Inquiring into cardiac risk factors such as hypertension, high cholesterol, smoking and diabetes, as well as family history, are important to properly assess the risk of myocardial ischemia in the patient. Failing to take a complete history can lead to missed diagnosis. Even patients especially in patients without prior cardiac history, early or mild symptoms of myocardial ischemia may not be taken seriously and attributed to less serious problems, such as gastroesophageal reflux, anxiety and costochondritis and muscle pain from exertion.
Cardiac disease is prevalent in the United States. Physicians in emergency departments and primary care settings need to have heightened awareness of the ways in which cardiac ischemia can present. Not all patients present with typical symptoms. A complete medical history, identification of risk factors, proper testing and the analysis of test results are important to ensure proper diagnosis and timely treatment of cardiac ischemia and infarction.
If you or a loved one has suffered an avoidable heart attack that has resulted in death or crippling heart damage our team of experienced malpractice attorneys and medical professionals can help answer whether negligence lead to that outcome.
Medical Malpractice

Combining Extensive Legal and Medical Knowledge
In any injury claim, medical issues are of paramount importance. Therefore, your lawyer must have a strong understanding of how these matters relate to your lawsuit. One of our firm’s partners, Armand Leone, is a board-certified diagnostic radiologist, in addition to being a lawyer. His intensive medical knowledge is invaluable in the investigation and litigation stages of every case. Our attorneys will work closely with you throughout your case to develop a strategy that suits your needs.