Caron Heyes backs urgent call to better understand heart attack warnings
The British Heart Foundation last week described new research that showed early warning signs of heart attacks are missed in up to one in six people as 'concerning'. Having seen the tragic consequences of misdiagnosis, I wholeheartedly agree.
The study, carried out by scientists at Imperial College London and published in the Lancet, illustrates that the wide array of symptoms displayed by people suffering a heart attack mean that medical professionals often don't pick up an episode until it's too late.
Researchers found that 16 per cent of people who died from a heart attack had been admitted to hospital within the previous 28 days but that many had no mention of heart attack symptoms in the notes.
The lead author of the study, Dr Perviz Asaria, admitted that doctors are very good at treating heart attacks when they are the main reason for admission, "but we don't do very well treating secondary heart attacks or at picking up subtle signs that might point to a heart attack death in the near future".
The problem appears to be that although classic symptoms such as fainting, shortness of breath and chest pain can be apparent, doctors miss the possibility of heart disease because there is no obvious damage to the heart. The other problem is that many heart attacks simply don't present in classical ways, meaning the patient is not considered at risk.
I'm currently working on a tragic case of a 49-year-old father of three who died at home in his bed from a heart attack, having been told by his doctor he had flu.
Ian's wife described her husband as 'superfit', very active, loving his job and generally in good health. Admittedly, he did smoke around five cigarettes a day, but rarely needed to visit the doctor. About four years before he died, a blood test had shown a poor lipid profile, encouraging him to keep an eye on cholesterol and his general life style.
Ian had recently bought a new bike and, after a ride, complained of pains in his arms and legs, which he put down to the exercise. A couple of days later, he came home early from work, saying he felt light-headed and exhausted. He was also sweating.
These symptoms continued for several days and eventually Ian went to his doctor, who took his blood pressure and told him he likely had flu. His wife was concerned that his blood pressure appeared to be low, when it had been relatively high in the past, and that the appointment had barely lasted 10 minutes.
Ian continued to feel exhausted and generally unwell and spent several days in bed. On the terrible morning of 22nd September, his wife woke up to find her husband dead beside her.
The tragedy for Ian is that the GP did not perform an ECG because he presumably didn't recognise Ian's symptoms as signs of an impending heart attack.
In the past, the treatment of heart attacks is generally considered one of the success stories of modern medicine. The study authors at Imperial College have now called for more urgent research and a change in the way doctors view heart attacks, including better clinical guidelines and more time to examine patients and look back at their records.
A spokesman for the Royal College of Physicians rightly said that the challenge is to accurately and quickly diagnose patients so that they can be offered the best care.
He also said education of the public, of GPs, paramedics and Emergency Department doctors is essential to improving the care of patients having a heart attack.
Hopefully, this vital message will generate a change in clinical culture and help save the lives of men like Ian.
Heart attack symptoms, source NHS
- Chest pain - a sensation of pressure, tightness or squeezing in the centre of the chest
- Pain in other parts of the body - it can feel as if the pain is travelling from the chest to the arms (usually the left arm is affected, but it can affect both arms), jaw, neck, back and abdomen
- Feeling lightheaded or dizzy
- Shortness of breath
- Feeling sick (nausea) or being sick (vomiting)
- Overwhelming sense of anxiety (similar to having a panic attack)
- Coughing or wheezing
Although the chest pain is often severe, some people may only experience minor pain, similar to indigestion. In some cases, there may not be any chest pain at all, especially in women, elderly people and people with diabetes.
By Caron Heyes
Caron is a solicitor in our Clinical Negligence team in London. She has pursued clinical negligence claims on behalf of patients across a broad spectrum of claim types, including obstetrics and gynaecology, neonatology, oncology, cardiology, Emergency, fertility and patient rights. Caron has a particular expertise in complex neonatal, obstetric, surgical mismanagement and accident claims and is experienced in providing advice and representation at inquests.
The Legal 500, and Chambers, UK, a Client's Guide to the Legal Profession, have repeatedly recognised Caron's expertise as a leader in the field of Clinical negligence, and recommended her as an "experienced, adept and supportive lawyer" and "a star associate".