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  1. #1
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    Default Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    My question involves medical malpractice in the state of: Minnesota
    Sitting here wondering if my family has a suit against the doctor/hospital that resulted in the death of my mother in law. First and foremost I believe the statute of limitations on a lawsuit for this matter is 3 years. Not 100% sure on this. \

    My mother in law was admitted to the hospital on a Monday mid morning. She had visited the doctor complaining of chest pains. (she is 53). The doctor at the clinic was concerned enough to have her transported by ambulance to the hospital for more testing. She was admitted.

    While in the hospital she under went a stress test, and was on a heart monitor the entire time she was there. My husband ( her son) and I went to the hospital to see her Monday night. While we were there her moniter alarmed 3 times or so. I being the worrier that I am started to question the nurse. The nurses response was vauge, but she didn't seem to be too upset. She just stated that she (my mother in law) was having some PVCs.

    She remained in the hospital for the main part of Tuesday to finish up the test and results from those tests.

    I called her Tuesday evening at about 7pm and asked her how things were going. She stated to me at that time the doctor had given her a "clean bill of health", and she was on here way home.

    Much to my surprise, my husband called me the next morning (Wednesday) having heard his Mom's address over his pager (he is a local volenteer fireman), saying there was a 50 some year old woman found unconcious. I at the time wasn't overly worried. After all she had just told me not even 12 hours earlier, that the doctor gave her a clean bill of health right? Much to my dismay however, my husband after leaving work and driving the 15 miles to his Mom's house found the police and ambulance there, only to find out that the had already called estimated time of death!!

    Are you serious???? How can she be released from the hospital, and dead not even 12 hours later????

    After autopsy:
    The Autopsy report reads:
    The most likely explanation of death is a fatal cardiac arrhythmia of unknown etilology. The myocarditis was focal and mild in the sections examined, but cannot be completely excluded as a contributing factor.

    Is this something her children should be looking into as a possible malpracitce issue??? Please help!

  2. #2
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    Default Re: Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    The administrator of the estate should have all of the relevant medical records reviewed by a malpractice firm. The answer to the question of whether there's a provable case of malpractice lies within the records, and without access we would only be able to make wild guesses.

  3. #3
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    Default Re: Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    Thanks for the response! I do agree with you that at this point it is all speculation. I have contacted a malpractice attorney, and they are going to let me know if they think it is a case worth looking into! Thanks again!

  4. #4
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    Default Re: Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    just a note: pvc's are common and often symptoms of a benign cause. A very large percentage of the population experience pvc's or other arrhythmias on a regular basis. It itself, the presence of pvc's or some other arrhythmia and no treatment is not evidence of negligence.




    The entire ER history will have to be studied to determine if the symptoms and findings at the time indicated some other treatment be taken at the time. The fact that she was given a stress ECG while at the hospital would tend to indicate there were no findings of much of anything at the time. You don't have a person in cardiac distress perform a stress ecg. It is used as a tool to cause problems to surface that are not otherwise obvious.

  5. #5
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    Default Re: Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    Sorry for your loss. If you still read replies: The problem in this case was likely electrical, whereas the stress test is usually meant to uncover problems that arise from inadequate blood flow in coronary arteries. Myocarditis (heart muscle infection) can cause "heart block", which can lead to cardiac arrest. Myocarditis is notably hard to diagnose, unfortunately with the surest means being an autopsy. Otherwise there would need to be enough scoring on the Dallas Criteria to warrant literally taking a snip of heart muscle for biopsy.

    "The myocarditis was focal and mild in the sections examined, but cannot be completely excluded as a contributing factor."

    Which means it was not widespread, besides being mild. That also means a biopsy might not have found it, except by chance if a snip was taken from an infected spot.

    Ironically, the exercise on the treadmill might overcome heart block and give a more normal picture on the EKG.

    As you can see, it is complex. One possible avenue: if the myocarditis (usually painless) was accompanied by pericarditis, which is known for chest pain. Yet you didn't mention pericarditis. Then you'd have to show that they should have been able to distinguish pericarditis from the angina that comes with blocked arteries - which is what they tested for.

    I hope you're seeing an atty that specializes in cardiac cases, else he won't know how to begin evaluating this and whether he should incur the expense of consulting med experts - especially with cause of death being so unsure.

  6. #6
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    Default Re: Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    Quote Quoting medmal
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    Then you'd have to show that they should have been able to distinguish pericarditis from the angina that comes with blocked arteries - which is what they tested for.
    .
    where do you get that they tested for blocked arteries? It appears all that was performed was an ecg and a stress ecg. Neither of which tests for blocked arteries. Imaging tests are the only tests that will "test" for a blockage.

    Especially since the autopsy provided no evidence of occlusion of any veins/arteries of the heart that would have been considered as causation of death, their cause of death is "cardiac arrhythmia" which in itself, can be adequate to cause death. There was nothing, either in their tests nor in the autopsy, that would suggest there was any real concern of a blockage.

    and I can assure you that angina is not the only cause for pain, either in the chest in general or specific to the heart. Some types of arrhythmia itself can be the cause of considerable pain.

  7. #7
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    Default Re: Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    Quote Quoting jk
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    where do you get that they tested for blocked arteries? It appears all that was performed was an ecg and a stress ecg. Neither of which tests for blocked arteries. Imaging tests are the only tests that will "test" for a blockage.
    You are confused. Let's just take the first result from a websearch:
    https://ixquick.com/do/metasearch.pl...s+test+purpose

    http://www.surgeryencyclopedia.com/S...ress-Test.html

    "The stress test is particularly useful for detecting ischemia (inadequate supply of blood to the heart muscle) caused by blocked coronary arteries."

    When you say imaging, that is particularly ambiguous, since an arteriogram in the cath lab is very different than say, a Calcium Artery Scoring or an IVUS. And nobody goes to the cath lab without a stress test first, except if an MI has already been well established and there exists a medical emergency.

    Especially since the autopsy provided no evidence of occlusion of any veins/arteries of the heart that would have been considered as causation of death, their cause of death is "cardiac arrhythmia" which in itself, can be adequate to cause death. There was nothing, either in their tests nor in the autopsy, that would suggest there was any real concern of a blockage.
    Then what do you possibly think a stress test is done for?


    and I can assure you that angina is not the only cause for pain, either in the chest in general or specific to the heart. Some types of arrhythmia itself can be the cause of considerable pain.
    I don't see how your statement is pertinent, since an simple EKG would have should any arrhythmia.

    I've already mentioned pericarditis. Causes such as chondritis, gastritis, pulmonary embolism etc are immaterial to this case.

  8. #8
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    Default Re: Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    E=medmal;506851]You are confused. Let's just take the first result from a websearch:
    then prove me wrong. You show me an ecg strip of a person with cardiac atherosclerosis and explain how it shows such.




    http://www.surgeryencyclopedia.com/S...ress-Test.html

    "The stress test is particularly useful for detecting ischemia (inadequate supply of blood to the heart muscle) caused by blocked coronary arteries."
    it does this by causing symptoms to be noticed. It does not in itself diagnose a blockage. That requires imaging tests.

    When you say imaging, that is particularly ambiguous
    ,imaging; not ambiguous at all. an image is a visual representation of something. As such, an imaging test would be something that presents a visual representation of some aspect of the patient.

    since an arteriogram in the cath lab is very different than say, a Calcium Artery Scoring or an IVUS
    of course they are differnt. If they weren't, they wouldn't be called different things. What is relevant is they are all imaging tests.

    And nobody goes to the cath lab without a stress test first, except if an MI has already been well established and there exists a medical emergency.
    typically yes but more importantly was the OP not considered to be in the middle of a medical emergency?



    Then what do you possibly think a stress test is done for?
    to read the electrical impulses within the heart while the patient is under stress. How the results are used is the question. Arrhythmias have myriad causes. The ecg is the beginning of an attempt to discover an answer to determine the cause of whatever symptoms the patient is experiencing.



    I don't see how your statement is pertinent, since an simple EKG would have should any arrhythmia.
    first, not always. In fact, often times, arrhythmia do not present upon demand of connecting an ecg. As to pertinence; some arrhythmias cause pain. You seemed to suggest that because there was pain, it was pericarditus. I simply stated that pain can be associated with an arrhythmia with no other justification for the pain. In other words; sometimes it hurts when there is an arrhythmia and no other problem.

    I've already mentioned pericarditis. Causes such as chondritis, gastritis, pulmonary embolism etc are immaterial to this case.
    and I'm not talking about any of them either. Pain can be present when there is an arrhythmia that is of unknown cause. The best layman's explanation I can describe it as is: it would be similar to a muscle cramp.

  9. #9
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    Default Re: Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    Well, this thread is stretching out. I will address only the most important points, if you don't mind.

    Quote Quoting jk
    View Post
    then prove me wrong. You show me an ecg strip of a person with cardiac atherosclerosis and explain how it shows such.
    Sure, it's called ST segment depression, which usually indicates cardiac ischemia. Now, what is the usual cause of such ischemia? Yep, a blockage.

    I'll save you a little time searching, here is what is looks like:

    http://www.unm.edu/~lkravitz/EKG/stdepression.html

    Or wikipedia:
    https://secure.wikimedia.org/wikiped.../ST_depression

    which is not authoritative as we know but WP has almost zero chance of being wrong on something so basic.

    After seeing that pattern on EKG (or worse, seeing an *elevated* segment aka STEMI which indicates infarction), and seeing elevated cardiac enzyme blood tests, then yes the Pt probably goes to the cath lab for arteriogram and etc such as stenting, unless stenting is not an option then instead goes for CBG aka cabbage.

    So, a depressed ST usually indicates blockage which becomes apparent when demand for oxygen is increased by treadmill exercise.

    As might be expected, things are not so cut and dried; e.g. infarction can be present with elevated enzymes but the ST is still depressed and not elevated.

    typically yes but more importantly was the OP not considered to be in the middle of a medical emergency?
    no, they investigated that possibility and dismissed it else they wouldn't have sent her home.

    Here is my all around guess: the culprit was myocarditis. There was no arrhythmia on EKG, so they did a stress to further look for exercised-induced ischemia. None was seen, and neither troponins nor CPK were elevated, so she eventually went home. (It is unclear whether there ever was any pain while on a monitor.)

    That night, the inflammation caused by infection (probably viral) caused electrical disturbance which led to the tragic end. In fact, a history of a recent might give a hint. Also, the type of immune cells seen in the biopsy samples would give some indication.

    They experience of pain before admission could have been caused by two possibilities:
    1) pericarditis (not mentioned by the OP but not excluded by that) or an atypical myocarditis
    2) an arrhythmia, as you mention, caused by the myocarditis but which was very unfortunately transient so therefore not detected, but which recurred after leaving hospital - that time more severely which led to the tragedy.


    P.S. Thanks for your reply in my banter thread.

  10. #10
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    Default Re: Fatal Cardiac Arrhythmia Shortly After Discharge from Hospital

    The bottom line is though that the mother-in-law's medical records need to be taken to a medical malpractice
    attorney for review which it seems the OP was going to do.

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