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Friday, January 4, 2008

I was obviously wrong: A misdiagnosed heart attack

Dr. Sandeep Jauhar's story:
I got a call from the E.R. at my hospital. A young intern who had been on rounds that morning had been admitted with chest pains. He was 30, a Pakistani man with a long face and a disconnected look, which I attributed to anxiety. I asked him about the pain. It had started after dinner the night before, lasting about 10 minutes. The pain had recurred the next morning for almost an hour. It was a dense pressure in the center of his chest, so he had come to the E.R.

His blood tests were normal, as was his first electrocardiogram (EKG). I suspected he was suffering from acute pericarditis, a usually benjgn inflammation of the membrane around the heart, treated with over the counter drugs.

Before I left the hospital that evening, a physician's assistant asked me whether the intern should get an angiogram to rule out artery blockage. I told him any work-up could wait until morning, and assured him that a 30-year-old with no risk factors did not have coronary artery disease.

My patient had chest pains throughout the night. Further blood tests then showed evidence of continuing heart muscle injury. An EKG the following morning showed signs consistent with a heart attack. Though I still doubted that he had coronary disease, I reluctantly sent him to the cardiac catheterization lab for an angiogram.

The angiogram showed a comlete blockage of the left anterior descending artery, the "widow-maker" lesion. Within minutes, a balloon and stent opened the blockage.

I knew I had to explain myself, but how much should I say? Like all doctors, I had made errors before, but never one this big – and in my own specialty.

I couldn't bring myself to talk to my patient in the cath lab, while everyone was watching, so I decided to wait until he got to the recovery room, where it was more private.

I found him there lying on a stretcher. The pain in his chest was gone, he happily informed me. "I thought you had pericarditis," I said carefully. "I was obviously wrong. I’m sorry."

He seemed embarrassed. "No, no please, the past is finished," he said. "I am more interested in the future."

He asked about his prognosis. I told him that I thought it was good, though he would have to be on medications for the rest of his life. He nodded, looking disappointed.

A few days later, before he was discharged, I stopped by his room. I asked him with whom he was going to follow up He told me that he had been given the name of another cardiologist but that he had decided to go with me. "You have been terrific," he said. "Thank you."

Browse for related stories in the index at the very bottom of this page, or read an apology story.

Thanks to Dr. Sandeep Jauhar for the source story in the NY Times of Jan. 1.

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