Heart disease is the leading cause of death in the United States, accounting for roughly 1 out of every 7 deaths. Many of those deaths are from a heart attack or stroke. Nearly 800,000 Americans have a heart attack each year – approximately one every 40 seconds – and about 15% of those heart attacks are fatal. Roughly the same number of Americans have a stroke each year, but stroke has a slightly higher death rate and is also a leading cause of serious long-term disability.
A heart attack (or myocardial infarction) occurs when the blood flow to part of the heart is blocked, usually by a clot. If the blockage is complete, that part of the heart begins to die. Treatment for a heart attack aims to restore blood flow. Treatment options range from medication to surgical and other procedures (including cardiac catheterization and bypass surgery). The more time passes after the heart attack starts, the more tissue dies. The patient’s survival and long-term prognosis, therefore, depend on prompt diagnosis and effective treatment. A patient who survives a serious heart attack may still require lengthy cardiac rehabilitation and potentially even heart transplantation.
A stroke happens when a blood vessel that supplies the brain gets blocked (ischemic stroke) or ruptures (hemorrhagic stroke). Ischemic strokes account for approximately 80% of all strokes and can be either thrombotic (the clot forms in one of the arteries that supply blood to the brain) or embolic (the clot forms elsewhere in the body and is carried through the bloodstream to the brain). As with heart attacks, time is of the essence in the treatment for stroke. The gold standard treatment for ischemic stroke is tissue plasminogen activator (tPA), which dissolves the clot and restores blood flow, but tPA can only be used within a short period of time (as little as 3 hours) of onset of the stroke. The treatment for hemorrhagic stroke is surgery or other endovascular procedure to stop the brain bleeding.
Heart attacks and strokes do not always present the same way, but each condition has a range of generally accepted signs, symptoms, and risk factors (both lifestyle and medical) and clear medical standards of care govern the diagnostic decision-tree and, if the diagnosis is made, the interventions to be performed. Medical malpractice cases arise in this context when health care providers fail to act in accordance with these standards of care, resulting in untimely diagnosis or treatment.
Deviations from the standard of care often involve the failure to recognize signs and symptoms of heart attack or stroke or significant delays either in obtaining the necessary tests or acting on abnormal results. Such delays can occur in an outpatient or inpatient setting, particularly in an emergency department with long delays before a patient actually sees a physician. Women are more likely than men to have heart attack symptoms unrelated to chest pain, which sometimes leads physicians and “physician extenders” (like physicians assistants) alike not to act with the necessary urgency. Occasionally, the delay can result from the simple but unfortunate human tendency (even in the medical profession) to “normalize the abnormal” – attributing concerning signs and symptoms to less serious conditions and failing to suspect a heart attack or stroke.
The medical malpractice plaintiff must also prove that a delay in diagnosis caused or increased the risk of harm. Some heart attacks and strokes are so serious that it may be difficult to prove that the timeliness of the intervention had a significant impact on the outcome. In other cases, there is strong evidence that timely and appropriate intervention would have prevented serious permanent injury or death. For this reason, the patient’s attorney must retain well-credentialed specialists (e.g., interventional cardiologists, stroke neurologists) to carefully evaluate the medical records in light of current medical literature and research and provide well-supported causation opinions.
If you or a family member or friend has suffered a heart attack or stroke that you think may not have been timely diagnosed or treated, contact Youman & Caputo for a free consultation. The attorneys at Youman & Caputo have investigated and litigated many cases in both Pennsylvania and New Jersey involving the catastrophic consequences of significant delays in diagnosis of (or outright failures to diagnose and treat) heart attacks and strokes.