Claim settled for missed myocardial infarction

We have settled a claim on behalf of the estate and dependants of an elderly gentleman who attended St Peter’s Hospital in Chertsey with a myocardial infarction, but was sent home following a failure to check his troponin levels. As a result, he suffered a further, more severe infarction and died shortly afterwards.

Mr A was 85 at the time of the events. He had a number of pre-existing medical conditions including heart failure. He therefore had some breathing difficulties on a daily basis, but had collapsed at home with chest pain, and his breathing was far worse than normal.

He was seen in A&E, where the clinicians recognised the potential for a myocardial infarction, and he was admitted to a ward. An ECG was inconclusive, but blood samples including troponin were taken. ECGs do not always show definitive changes, and troponin is a sensitive marker of damage to heart cells which is generally elevated even in relatively minor heart attacks. It is therefore vital that this marker is checked if there is suspicion of a myocardial infarction.

Unfortunately, the laboratory machine in the hospital that measured troponin was broken on the day in question, and so Mr A’s sample was sent to a neighbouring hospital, resulting in a slight delay in receiving the result. In the meantime, given Mr A’s apparently reasonable clinical condition, and other normal blood results, paperwork was drawn up to discharge him, on the condition the troponin levels were normal once they were received.

In fact the troponin levels were significantly elevated, a definite indication of an ongoing myocardial infarction. However, an issue with communication between shifts meant that no one reviewed the troponin levels on the computer system, and Mr A was sent home with instructions to return for review in four days.

Over the next four days, Mr A continued to suffer increasing shortness of breath and chest pain. He returned as instructed, but still the troponin levels were not reviewed for a further 24 hours. Eventually a consultant reviewed the previous troponin results, and ordered another test, showing significant further damage to the heart.

By this stage, Mr A’s heart had been damaged to the point where his ejection fraction (the ability of the heart to pump) had been reduced to about 20% of normal and he was considered too high a risk to undergo angioplasty (dilation and/or stenting) of the blockage. Some medical treatment was instigated, but he suffered four cardiac arrests and died around two weeks after the initial events.

Given the clear failures that we identified in Mr A’s care, an early invitation to admit liability was sent to the trust. Liability was admitted promptly, and the claim was settled for £24,000. This included a bereavement award to Mr A’s widow, funeral expenses, and damages to Mr A’s estate for pain, suffering, and loss of amenity.

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