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Despite the abundance of knowledge available about heart attacks, out of the 5 million patients admitted to the emergency room for chest pain, 2 percent to 8 percent are mistakenly discharged with an alternative diagnosis. [1] That makes heart attacks the most misdiagnosed condition. [2] A missed diagnosed heart attack may result in a seriously life-threatening outcome. Patients who survive an undiagnosed heart attack or a delayed diagnosis frequently develop more complications than patients who receive a correct diagnosis.

What is a Heart Attack?

Heart disease is the leading cause of death of both men and women in the United States. A heart attack is a form of heart disease. According to the American Heart Association, a heart attack strikes someone about every 34 seconds.

A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or stopped. This happens because coronary arteries that supply the heart with blood can slowly become thicker and harder from a buildup of fat, cholesterol and other substances, called plaque. This slow process is known as atherosclerosis. When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction. [3]

Symptoms Which May Lead to a Heart Attack

Most heart attacks start slowly, with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help. A person may be experiencing cardiovascular problems if ordinary physical activity causes them to experience the following symptoms, which can vary, depending on the severity of the attack:

  • Undue fatigue
  • Palpitations – the sensation that your heart is skipping a beat or beating too rapidly
  • Dyspnea – difficult or labored breathing
  • Chest painchest pain or discomfort from increased activity. Most heart attacks involve discomfort near the center of the chest that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
  • Discomfort in other areas of the body – symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach
  • Other signs – may include breaking out in cold sweat, nausea or lightheadedness.

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea or vomiting, and back or jaw pain. [4]

Misdiagnosis of a Heart Attack

Chest pain is one of the most common reasons for which patients are admitted to the emergency room (20 percent to 30 percent of medical admissions)[5] and the classic symptom of a heart attack.

“The No. 1 symptom that we typically look for,” says Jean C. McSweeney, PhD, RN, associate dean for research at the University of Arkansas for Medical Sciences College of Nursing in Little Rock.

But not all heart attacks cause chest pain, and chest pain can stem from ailments that have nothing to do with the heart.”[6] The symptoms of a heart attack are similar to many other conditions and doctors are responsible to be careful not to mistake heart attack symptoms with other medical problems.

There are as many as 84 causes of chest pain [7] including:

  • Heartburn
  • Acid Reflux
  • Esophagitis
  • Angina
  • Pneumonia
  • Bronchitis
  • Psychological Disorders
  • Musculoskeletal Conditions
  • Gallstones.

Diagnosis: How do I know if a Heart Attack has occurred?

Similarity of symptoms is the leading factor in heart attack misdiagnosis. A healthcare provider can diagnose a heart attack based on several assessment findings. These include:

  • The patient’s complete medical history
  • A physical examination
  • An electrocardiogram (ECG or EKG) to discover any abnormalities caused by damage to the heart. An ECG is a medical device that makes a graphical record of the heart’s electrical activity.
  • Blood testing to detect abnormal levels of certain enzymes in the bloodstream. [8]

Missed diagnosis of a heart attack is consistently one of the top reasons for litigation against emergency room physicians. This problem has spawned a large number of investigations into the safest most cost-effective strategies for clinical assessment, diagnostic performance, and triage. [9]

In 2004, the American College of Cardiology of the American Heart Association recommended that all hospitals implement written protocols for the management of patients who present with symptoms suggestive of heart attack. These protocols dictate what steps must be taken by emergency room department personnel to properly handle these patients, including seeing patients within 10 minutes [10].

Chest pain patients take a lot of work and less than 15 percent of patients admitted in the emergency room are actually experiencing a heart attack [11]. This can cause negative reinforcement, and medical staff can let their guard down. A misdiagnosed heart attack can be the difference between life and death.

You can contact our medical malpractice attorneys for more information.

Risks Associated with Heart Disease

Controllable factors that affect the risk of heart disease include:

  • Smoking
  • High Blood Pressure
  • High Cholesterol
  • Diabetes
  • Being Overweight or Obese
  • Physical Inactivity.
[1] Swap CJ, Nagurney JT, Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA. 2005;294:2623-2629.
[2] https://www.cbsnews.com/news/most-common-medical-malpractice-claims-for-missed-cancer-heart-attacks/
[3] https://www.heart.org/HEARTORG/Conditions/HeartAttack/AboutHeartAttacks/About-Heart-Attacks_UCM_002038_Article.jsp
[4] https://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Symptoms-and-Diagnosis-of-Heart-Attack_UCM_002041_Article.jsp
[5] Pierard A, Luc. Echocardiography in the emergency room. Heart 2009;95: 164-170.
[6] https://www.webmd.com/heart-disease/features/12-possible-heart-symptoms-never-to-ignore
[7] https://www.healthline.com/symptom/chest-pain
[8] https://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Symptoms-and-Diagnosis-of-Heart-Attack_UCM_002041_Article.jsp
[9] Ghaemmaghami, Christopher, Pitfalls in the emergency department diagnosis of acute myocardial infarction. EMERGENCY MEDICAL CLINICS OF NORTH AMERICA. 2001;19:351-369.
[10] https://nihlibrary.ors.nih.gov/jw/POC/Uacs.htm
[11] https://www.scpcp.org/webdocs/cpc-moving-toward.pdf

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