Around the world, millions of people die each year from cardiovascular disease, and in the United States, it is the leading cause of death. A heart attack is defined as an injury to the heart muscle resulting from a lack of oxygen-filled blood. An interruption of the flow of blood to the heart can be caused by a blood clot, atherosclerosis, or a coronary artery spasm.
By the nature of the disease they are treating, cardiologists are frequently handling patients with life-threatening illnesses. Cardiology patients often die during treatment. Therefore, it is important to distinguish between a poor outcome that is the natural result of a patient’s cardiac disease and a poor outcome that is related to deviations from accepted standards of care on the part of a treating physician.
When a patient appears in the emergency room complaining of chest pain, the staff should be looking for symptoms that are consistent with a potentially life-threatening cardiac condition even though not all chest pain is caused by the heart. The nature of the patient’s complaint is often helpful in making a proper diagnosis. Often, cardiac pain is associated with shortness of breath, sweatiness, nausea or vomiting, and neck, jaw, or arm pain. Although half of all heart attack victims have warning signs hours, days, or weeks in advance of the attack, heart attacks in women, in older adults, and in people with diabetes tend to be less pronounced.
The standard of care for emergency room patients complaining of chest pain lasting several minutes each in an increasing pattern is normally immediate hospitalization and the ministering of appropriate medications. If a patient suffers from a prolonged episode of chest pain, the standard of care is to hospitalize the patient in an intensive care setting for constant monitoring of his or her heart rhythm.
A normal electrocardiogram does not necessarily rule out a cardiac source of chest pain. Therefore, a normal electrocardiogram should not, by itself, rule out hospitalization of a patient complaining of chest pains. Similarly, cardiac enzymes may be normal for a period after a heart attack and must be further evaluated.
Some chest pains do not originate from heart disease. For example, chest pain that is very fleeting and lasts only for a few seconds is very unlikely to be related to a cardiac problem, and, depending on the facts of the specific situation, it might be within good and acceptable medical standards of care to dismiss a cardiac diagnosis and to allow that patient to leave the emergency room.
When a patient has been admitted to a hospital with a preliminary diagnosis of unstable angina or a heart attack and the pain recurs, the standard of care requires an increase in medical treatment, including higher doses or additional medications. Recurrent chest pain is a symptom of increased risk of another heart attack and cardiac death. Therefore, those patients usually require cardiac catheterization with the potential of coronary angioplasty or coronary artery bypass surgery.
If a patient goes to his or her own doctor rather than to the emergency room for treatment of chest pain or discomfort, the standard of care calls for the primary care physician to perform a cardiac evaluation first because of the life-threatening nature of heart disease. The physician might start the evaluation procedure or might immediately refer the patient to a cardiologist. In either case, the administration of oral nitroglycerin would be helpful both diagnostically and therapeutically. If the nitroglycerin relieves the chest pain, a heart-related source of the problem is strongly indicated.
Copyright 2012 LexisNexis, a division of Reed Elsevier Inc.
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