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  1. #1
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    Default Cardiologist

    My question involves medical malpractice in the state of: North Carolina

    First, I am SORRY for making this long but it is the shortest I could make it to include ALL the relevant details.

    I was referred to a cardiologist by my pediatrician for a murmur. On the referral form it says "Evaluate new murmur - possible functional". Pediatrician also sent me to a hospital for EKG, which I get done at hospital. Then, days later, I get this voice message from my pediatrician's nurse:

    "Left side is enlarged - not sure what's going on - what significance does that mean. I would definitely keep your appointment, they [cardiologist referred to] will discuss the EKG. They'll have this record and go into details of what this means."

    However, I heard this message after my visit to cardiologist.

    So anyway, I see my cardiologist. We talk about some unrelated stuff and then he briefly asks me some questions. "Do you get chest pain when you're walking, active?" I couldn't finish answering this because I am interrupted. "Does your heart flutter" Couldn't answer this one either because cardiologist interrupts with the following question "Do you ever pass out?" I said 'No'. Then, "Do you have swelling in your legs?" 'No', again. "Do you feel dizzy when you stand up?" 'Maybe like 1 time', was my answer. "Have you ever had a blood clot?" 'No'. "Does your dad have heart trouble?" my answer: 'Yes.' "What kind?" 'I don't know.' "Is there anyone in the family who died suddenly?" 'Yes, my great-grandmother.'

    Later on, after testing blood pressure, listening to heart, etc., cardiologist asks me a second time whether I've had swelling in my legs, to which of course I say 'No.' Then asks me if my chest pain gets worse with certain food and not with activity or anything else, to which I said 'Yes, but I still had chest pain after fasting (so it wasn't caused by food).'

    Towards the end, he schedules me an ultrasound of heart to see what my murmur is, and noted that he doesn't think it may be "anything serious", and an ultrasound of arteries in neck. He then says "I think we're going to find that your heart is okay ... and if that's the case, things are fine."

    In the very end I notice that my cardiologist says absolutely nothing about the EKG he was supposed to "go into details" and that he's preparing to leave, so I ask him about the EKG. His response: "EKG was beautiful." So I get the ultrasounds done, come home, listen to my voice messages and hear my pediatrician's nurse voicemail that says that the EKG showed enlargement. At this point I panic and experience something akin to a trauma. I get extreme worries that my cardiologist has lied to me and wants me to die. I remember that I actually get mixed thoughts; I'd think that maybe nothing can be done to my heart now so I am being lied to and my actual prognosis is death.

    A day or two later I receive a call from cardiologist's nurse. She says ultrasound of heart was a "normal study - normal pumping function or squeezing function of heart, no valve disease. So that was a good report ... Ultrasound of arteries showed no plaque on either side and [cardiologist] is not suggesting any changes here. Those [studies] looked really good."

    Other pertinent events:

    In February of 2012 I experience unusual squeezing chest pain with palpitations that began when walking. It was so bad I was considering going to the hospital's trauma center, but did not.

    In March of 2012 I go to my local hospital, with which my cardiologist is affiliated, because of very bad chest pain. I will not share any more information as I do not want to sue the hospital.

    In that same month, I have a scheduled follow-up visit with my cardiologist. The only relevant thing I can remember from that visit is that he tells me my heart is "strong" and that I can go swimming. I also got a stress echocardiogram, which, like the first tests, was normal. Below are the details of stress exercise test results:

    "A treadmill exercise test according to Ramped Bruce protocol was performed. The baseline ECG displays normal sinus rhythm. No stress induced ST changes to suggest ischemia. Total stress time achieved was 1.6 minutes. A total of 2.7 METS was achieved. This represents 10% of the expected exercise capacity.

    Resting heart rate was 108 BPM. Peak heart rate achieved was 131 BPM. This represents 65% of maximum predicated heart rate. Exercise was stopped due to leg pain. Blood pressure at rest was 128/80 mmHg. Blood pressure at peak stress was 138/74 mmHg. No arrhythmia was noted during stress. There was no new ST segment depression with stress. The left ventricle is normal in size. There is no thrombus. There is normal left ventricular wall thickness. Left ventricular systolic function is normal and is estimated at >55%. No regional wall motion abnormalities noted. The right ventricle is grossly normal size.

    The left atrium is normal size. Right atrial size is normal. The mitral valve is normal. There is no mitral regurgitation noted. The tricuspid valve is normal in structure and function. No tricuspid regurgitation. The aortic valve moves normally. No hemodynamically significant valvular aortic stenosis. No aortic regurgitation is present. The pulmonic valve is normal in structure and function. There is no pulmonic valvular regurgitation. The aortic root is normal size. The pulmonary artery is normal size. There is no pericardial effusion. There is no pleural effusion. A complete treadmill stress with two-dimensional transthoracic echocardiogram was performed (2D, M-mode, Doppler and color flow Doppler). Technically limited apical views due to cardiac positioning. Low workload achieved. No ischemia at sumaximal heart rate. Left ventricular systolic function is normal and is estimated at >55%. No obvious regional wall motion abnormalities noted."

    Here is why I am asking if I can sue this cardiologist:

    In May of 2012 I get an echocardiogram at a very reputed hospital, one of the best in my state.This echo shows:

    "Normal left ventricular size. Normal left ventricular systolic function. Normal left ventricular wall motion. Normal right ventricular size. Normal right ventricular function. Mild mitral regurgitation. Mild tricuspid regurgitation. Small pericardial effusion. Anterior mitral leaflet prolapse with posteriorly directed jet. Severity of MR jet could be underestimated due to the eccentric jet."

    Then says, "Consider echo follow-up."

    I also got an EKG at this hospital, which, interestingly, only showed Sinus Tachycardia and no enlargement of heart.

    So, do I have a case here and if so, how much would I win, assuming I can find a lawyer and still sue after 2 1/2 years? Also, even though I have seen psychiatrists/psychologists and complained a lot about the trauma received from my experience with this cardiologist and the complete distrust I now have in doctors as a result of the lies, I do NOT wish to include the psychological side in my lawsuit, just the lies.

    I am also worried that the cardiologist will argue the prolapse was missed because it's just one leaflet and that my condition worsened in those two months (from stress echo to abnormal echo at reputed hospital). Or, that it simply appeared on that echo and not his as prolapses may rarely go away and re-appear. However, I still do not understand how he acknowledged the murmur I was referred with and then told me the echocardiograms show no regurgitation. I mean, my referring pediatrician said the murmur was III/IV and harsh.

    Want expert opinions only and will possibly recompense for honest, helpful advice. Thank you.

  2. #2
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    Default Re: Cardiologist

    I don't see that you have a case. Doctors in general look at the reports generated from these tests and based on their experience make decisions in accordance with the patients review of symptoms. A pediatrician is not a heart specialist.

  3. #3
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    Default Re: Cardiologist

    Quote Quoting Disagreeable
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    I don't see that you have a case. Doctors in general look at the reports generated from these tests and based on their experience make decisions in accordance with the patients review of symptoms. A pediatrician is not a heart specialist.
    Did you even read the whole thing?

  4. #4
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    Default Re: Cardiologist

    Go see a med mal attorney if you believe you have a case.


    Quote Quoting disabled1
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    Did you even read the whole thing?

  5. #5
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    Default Re: Cardiologist

    How old were you when you first visited the cardiologist? Are you now an adult? You mention psychiatrists. Do they have a diagnosis of your current mental condition? Are you taking any drugs?
    It's quite believable that a mild heart murmur would not require treatment. It's not clear whether your current heart issues have anything to do with your previous cardiology visits.
    In the local phonebook there will be a number of attorneys who specialize in medical malpractice and will offer a free initial consult. If you are an adult, call a few.

  6. #6
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    Default Re: Cardiologist

    I suspect Disagreeable skimmed your post, as you have stated that you want to sue your cardiologist; but he otherwise hit the salient point.

    As it stands we're not able to determine from what you posted whether or not the cardiologist's interpretation of the test fell below the standard of care, or even if he made an error interpreting the test. You have not told us about the testing from the local hospital that occurred in March, 2012, or if it differed in result from the cardiologist's findings. Your May findings suggest that the cardiologist's examination may have been accurate based upon what he observed, as "Severity of MR jet could be underestimated due to the eccentric jet" -- basically, the jet can be visualized in two dimensions, but with the third dimension of the flow not observable from one view. That would also explain why the cardiologist might hear a murmur, but not observe it on the tests -- it's possible that the cardiologist should have considered testing on a different modality in order to clarify why he heard something that did not appear on the objective tests, but that's not an assessment we can make without review of the medical records. It also does not appear to be either the cause of your concern or that you suffered injury as a result of the failure to diagnose MR.

    To prevail in a medical malpractice case you must establish (1) the standard of care; (2) a breach of the standard of care; (3) proximate causation; and (4) damages. Kerr v. Long, 189 N.C. App. 331, 657 S.E.2d 920 (2008). You cannot prevail in a malpractice case unless you prove that you were injured as a result of the alleged malpractice. I'm not clear on what you believe your damages to be. You don't indicate that you have suffered any injury or medical complication due to the two month delay between your cardiologist's finding that you did not have mitral regurgitation and the new hospital's finding that you did have mitral regurgitation. As it stands, you have not identified any economic injury, you have not identified any physical injury, and you state that you do not wish to claim any psychological injury. If the only injury you claim is psychological but you won't raise that claim in court, you cannot sustain a lawsuit.

    In terms of the cause of your stress, you've given us no basis to believe that your cardiologist was responsible for the statement from your pediatrician's secretary that the EKG showed enlargement -- you've told us, to the contrary, that your cardiologist said that the EKG was "beautiful". You have not indicated that you followed up with the cardiologist after being told about possible enlargement by your pediatrician, despite being contacted by the cardiologist's office a day or two later and again being assured that in the cardiologist's opinion you had no such problem. The only source of worry that you have identified is the statement from your pediatrician's office that your tests showed cardiac enlargement, and that should have been resolved by the reaffirmation by the cardiologist's office, a day or two later, that the cardiologist saw no such abnormality.

    Is there anything that you would like to clarify?

  7. #7

    Default Re: Cardiologist

    A mitral valve prolapse is definitely not a death sentence. Some people have this for years and years and may only periodically cause issues. I think the appropriate thing for you is to make sure you get it followed up on a schedule determined by you and your doctor. I thought it was interesting that you said you didn't want the "psychiatric" part coming into play in a lawsuit. You can be sure your records with the psychiatrist will be subpoenaed as well. But it looks to me like your doctor is following up appropriately unless you can think of something your doctor failed to do.

  8. #8
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    Default Re: Cardiologist

    Quote Quoting Disagreeable
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    Go see a med mal attorney if you believe you have a case.
    Out of the 50 I called I only got 5 or so potential lawyers because they mostly say there is no physical injury and that mental injury won't make me money.

    Quote Quoting DaveM
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    How old were you when you first visited the cardiologist? Are you now an adult? You mention psychiatrists. Do they have a diagnosis of your current mental condition? Are you taking any drugs?
    It's quite believable that a mild heart murmur would not require treatment. It's not clear whether your current heart issues have anything to do with your previous cardiology visits.
    In the local phonebook there will be a number of attorneys who specialize in medical malpractice and will offer a free initial consult. If you are an adult, call a few.
    I was 19. I am now 22. My current mental diagnoses are: Social Anxiety, Social Phobia, Anxiety, and Schizophrenia (Paranoid). I used to take drugs for the supposed schizophrenia but stopped and only take drugs for sleep as I have a sleep disorder, and some clonezapam for my anxiety. Basically, after thinking I was going to get disability income and waiting a year for that I calmed down and of course had my mental condition improve. When I was denied I worsened so bad that I was hospitalized for persecutory delusions, suicidal ideation. These were all linked to the trauma I received from cardiologist lying. I was going to show everyone evidence of doctors lying and then kill myself (my ideation...) and my persecution was actually that doctors are persecuting me.

    No, it's not just a "mild heart murmur" it's a symptomatic MVP w/ a murmur as a result of the disorderly valve that was mild-moderate in severity then and now is just mild (I guess). Yes, that is my biggest problem: Showing problems caused by cardiologist's negligence, not the actual MVP (just as MVP dysautonomia).

    Quote Quoting Dogmatique
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    Honest opinion:

    MVP is very common and carries very little risk of long term damage. Yours sounds like it's in that category and I'm doubtful you could find any attorney to take the case. It's actually common for it to be an incidental finding, along the lines of "Huh..bit of regurg..noted...right, next thing".

    (If anything it looks like you're doing just fine)

    Sorry.
    Well, my prolapsing valve was giving me mild to moderate regurgitation. I strongly believe that if the original audio and video of my heart were reviewed we'd see a regurgitation and very clearly caused by a prolapse. I also had tricuspid regurgitation and this too can be caused by the prolapse. What I can definitely prove is that a grade III/IV harsh murmur with very loud sounds on the echo machine should shove some kind of regurgitation. The cardiologist denied everything and said my heart test was "really good." The cardiologist's office, after having a little argument, even said that their echocardiograms are better than the one I had done at my hospital. The cardiologist wrote on the records that he simply did not "mention" I had prolapse and regurgitation, whatever that means...

    Yes, it's not serious, but I was lied to and I want to be compensated for my mental suffering and for being fed lies for half a year.

    Quote Quoting Bubba Jimmy
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    I read the whole thing. As a lay person, I do not believe it is possible to reliably or conclusively diagnose enlargement from an EKG, but my opinion on that is immaterial. In order to bring a claim against that cardiologist you would have to be able to prove that s/he did not observe the standard of care that would be exercised by the reasonably prudent cardiologist in your area. Further, you would have to prove that such "malpractice" (i.e. failure to exercise due care) was the proximate cause of harm you have suffered. If nothing bad has happened to you, then even if the doctor is incompetent and failed to exercise due care, then you would not be able to state a valid claim in a lawsuit.
    Why not just show that he lied on the echo results? Isn't this not observing the standard of care? The only bad thing that happened to me that I can prove right now is all the mental problems I mentioned. I need my EKG w/ enlargement reviewed by other cardiologists (yes, another cardiologist actually said it showed enlargement) to know 100% there is or isn't enlargement. If there is, and I was lied to and something could have been done to prevent my symptoms like fatigue and chest pain I have now (along with a stress echo and a new echo now for possible ischemia I guess and anything else), then I will have physical injury, correct? I just don't understand how lying to a patient is not in itself a cause for a medical malpractice case.

    Quote Quoting Mr. Knowitall
    View Post
    I suspect Disagreeable skimmed your post, as you have stated that you want to sue your cardiologist; but he otherwise hit the salient point.

    As it stands we're not able to determine from what you posted whether or not the cardiologist's interpretation of the test fell below the standard of care, or even if he made an error interpreting the test. You have not told us about the testing from the local hospital that occurred in March, 2012, or if it differed in result from the cardiologist's findings. Your May findings suggest that the cardiologist's examination may have been accurate based upon what he observed, as "Severity of MR jet could be underestimated due to the eccentric jet" -- basically, the jet can be visualized in two dimensions, but with the third dimension of the flow not observable from one view. That would also explain why the cardiologist might hear a murmur, but not observe it on the tests -- it's possible that the cardiologist should have considered testing on a different modality in order to clarify why he heard something that did not appear on the objective tests, but that's not an assessment we can make without review of the medical records. It also does not appear to be either the cause of your concern or that you suffered injury as a result of the failure to diagnose MR.

    To prevail in a medical malpractice case you must establish (1) the standard of care; (2) a breach of the standard of care; (3) proximate causation; and (4) damages. Kerr v. Long, 189 N.C. App. 331, 657 S.E.2d 920 (2008). You cannot prevail in a malpractice case unless you prove that you were injured as a result of the alleged malpractice. I'm not clear on what you believe your damages to be. You don't indicate that you have suffered any injury or medical complication due to the two month delay between your cardiologist's finding that you did not have mitral regurgitation and the new hospital's finding that you did have mitral regurgitation. As it stands, you have not identified any economic injury, you have not identified any physical injury, and you state that you do not wish to claim any psychological injury. If the only injury you claim is psychological but you won't raise that claim in court, you cannot sustain a lawsuit.

    In terms of the cause of your stress, you've given us no basis to believe that your cardiologist was responsible for the statement from your pediatrician's secretary that the EKG showed enlargement -- you've told us, to the contrary, that your cardiologist said that the EKG was "beautiful". You have not indicated that you followed up with the cardiologist after being told about possible enlargement by your pediatrician, despite being contacted by the cardiologist's office a day or two later and again being assured that in the cardiologist's opinion you had no such problem. The only source of worry that you have identified is the statement from your pediatrician's office that your tests showed cardiac enlargement, and that should have been resolved by the reaffirmation by the cardiologist's office, a day or two later, that the cardiologist saw no such abnormality.

    Is there anything that you would like to clarify?
    This is by far the best reply I have received. You do indeed live up to your nickname.

    My reply:

    How come? I was referred with a grade III/IV harsh murmur that was heard on the echo machine. I heard it and have it recorded. I'm sure if we get this audio and the video we can see that there's a murmur and caused by the prolapse, as the honest doctor said it is. The testing at the local hospital, with which the lying doctor is affiliated, basically got me a chest X-ray and an ultrasound of abdomen and then discharged me with diagnosis "Abdominal Pain Unspecified" when my chief and biggest problem was chest pain for which they gave me morphine. I don't even remember mentioning any abdominal pain but whatever. They did also do an EKG which they said was normal (like all my EKGs have been except my very first one with enlarged heart).

    Here are the modalities used in the one with no diagnosis and in the one with diagnoses:

    No diagnosis:
    Echo: Complete two-dimensional transthoracic echocardiogram was performed (2D, M-mode, Doppler and color flow Doppler)
    Stress echo:Same.

    Diagnoses:2D Complete with spectral and color flow doppler.

    If this is not it, how do I find the modalities? Where are they in the echo result?

    And even if the cardiologist didn't use the right modality, that's a deviation from standard of care as the result was a misdiagnosis when I actually had a valve problem...

    Again, it's not just mitral regurgitation that was missed, it was the cause of it (the prolapsing valve), and the tricuspid regurgitation and pericardial effusion. I am willing to grant that in those 2 months I started having a mild tricuspid regurgitation because of worsening and a pericardial effusion, but that's it.

    There was an economic injury as I could not start any work due to fatigue (how can I prove it's a result of my mitral valve *sigh*) but mainly the psychological injury. But I can't get a medical malpractice case without damages, even if I can prove the cardiologist knew I had such and such but decided not to tell me and instead lie? I have to claim psychological injury I guess.... It's just that I don't know I can prove they resulted from cardiologist as no psychiatrist/psychologist to my knowledge has said this. They're just mostly silent when I complain about cardiologist. And say I can prove mental injury, how much money will I make if lawyer gets like half of winning? I don't think I will find a lawyer if we both get little... *Sigh*

    - - - Updated - - -

    Quote Quoting Nursekd
    View Post
    A mitral valve prolapse is definitely not a death sentence. Some people have this for years and years and may only periodically cause issues. I think the appropriate thing for you is to make sure you get it followed up on a schedule determined by you and your doctor. I thought it was interesting that you said you didn't want the "psychiatric" part coming into play in a lawsuit. You can be sure your records with the psychiatrist will be subpoenaed as well. But it looks to me like your doctor is following up appropriately unless you can think of something your doctor failed to do.
    Why do you think I waited so long to seriously consider suing? I have been scammed by my SSA office of disability when I returned my reconsideration papers and waited a long time only to return to them and find out that they NEVER got any reconsideration request.... So I got tired of this route and wanted some money for the lies and mental suffering. I currently get a family doctor to listen to my heart every 3 months so it's nice. Yeah, ur right it will be subpoenaed so ye i dont have a choice... And yeah, my cardiologist failed effing diagnose my conditions and only acknowledged them after the echo done at new hospital (yes i went to him a third time and he was spent more time with me and actually shook my hand this time )

  9. #9
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    Default Re: Cardiologist

    Quote Quoting disabled1
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    Yes, it's not serious, but I was lied to and I want to be compensated for my mental suffering and for being fed lies for half a year.
    You seemed to be focused on the enlargement issue, and your reaction to being told by the pediatrician that you had an enlarged heart. You now appear to be casting that aside and focusing on the MR. But if you thought you mitral valve was functioning properly between the March evaluation by the cardiologist and the May evaluation by your new hospital, you would not have suffered any mental distress from the cardiologist's diagnosis -- you would have thought your heart was in better shape than it actually was (or may have been).

    You stated that you saw the cardiologist in March and received the correct diagnosis at the new hospital in May. I count that as two months, not half a year. What am I missing?
    Quote Quoting disabled1
    Why not just show that he lied on the echo results?
    You have not presented us with any evidence that the cardiologist lied about anything.
    Quote Quoting disabled1
    I need my EKG w/ enlargement reviewed by other cardiologists (yes, another cardiologist actually said it showed enlargement)...
    If your EKG in fact suggests enlargement, it was not inappropriate for your pediatrician's office to bring that to your attention, even if your cardiologist thought it was not an issue.
    Quote Quoting disabled1
    ...and something could have been done to prevent my symptoms like fatigue and chest pain I have now (along with a stress echo and a new echo now for possible ischemia I guess and anything else), then I will have physical injury, correct?
    If you had to have surgery due to your MR, and you suffered injury due to the delay in surgery, then you would point to the delay in diagnosis as having caused or contributed to that injury. But if you have done nothing differently or suffered no injury, then there's nothing to point to.

    So the question is not what "could have been done" -- more than two years have passed. What has been done, and how was it affected by the delay?
    Quote Quoting disabled1
    And even if the cardiologist didn't use the right modality, that's a deviation from standard of care as the result was a misdiagnosis when I actually had a valve problem...
    It's only a potential issue if, given the governing standard of care and the test results, the standard of care would require additional testing. Not every negative or ambiguous test result necessitates retesting on a different modality.
    Quote Quoting disabled1
    There was an economic injury as I could not start any work due to fatigue (how can I prove it's a result of my mitral valve *sigh*)
    Once you had the proper diagnosis, what changed in the treatment of your condition that resolved your fatigue? Do your treating physicians relate your fatigue to your MR?
    Quote Quoting disabled1
    And say I can prove mental injury, how much money will I make if lawyer gets like half of winning? I don't think I will find a lawyer if we both get little...
    A lawsuit against the cardiologist is apt to cause a law firm to incur somewhere between $30,000 and $100,000 in expenses, not inclusive of office overhead and staff costs or the value of the attorney's time. The likely recovery has to justify that sort of investment.

  10. #10
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    Default Re: Cardiologist

    Wow, I never even thought to mention I have a heart murmur on my SSDI app of course I did list about 20 some medical issues. I think the days of becoming an adult and developing several psychiatric disorders so SSI will support you for life are mostly over. The taxpayers are not in the business of picking up where your parents failed. I wish the multiple sleep disorders and anxiety I have were all of my medical issues. I take sleeping pills and klonopin in addition to many other meds. I also have a history of physical issues suffered for decades while I worked. I suggest you go have a few accidents and develop something severe if you want SSI. Severe psychiatric issues because you chose not to work and counted on SSI approval!!! Seriously? Dude I am losing over $40 per hour because of real issues. I could go back to work tomorrow if I was not so broken.

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