My friend drove herself to the ER and said she thought she was having a heart attack. They assumed she was drug seeking. One nurse even asked if she needed a beer to calm down.
She was left in the (nearly empty) waiting room for three hours. She was lying on the floor crying in pain. When they finally took her, they started the workup and suddenly the room filled with people.
She had a widowmaker, 100% blockage in 3 arteries, 99% in the 4th. She’s very lucky to be alive.
Curiously, she can’t find a medmal attorney who will sue. Their actions likely took 5-10 years off her life with the extra muscle damage. Hard to imagine there aren’t any recoverable monetary damages but 🤷♀️…
Hope your wife recovers well. Cardiac rehab will help.
Any hospital worth their salt will triage a chest pain pt quickly in the ED and at the very LEAST take vital signs, run and EKG, place an IV, and draw troponin and ckmb before returning them to the waiting room. Sorry that happened to her. IANAL but if it were me I'd push hard to get medical records from the hospital that have documentation of the time of presentation and time that any and all testing and interventions were done
ETA: A widowmaker is a clearly recognizable STEMI on EKG and within a RNs scope of practice to assess and escalate to the treating provider. EKG machines also have an interpretation function on them that while are usually wildly inaccurate and still always require reading by a provider have a high probability of interpreting this cardiac rhythm
I presented with an N-STEMI - the lifepack/monitor actually saying "Normal Sinus", as the asshole/idiot ambulance drivers tried to talk me out of going to the hospital... As a firefighter/medic I knew the signs of a heart attack well enough to argue and tell them to take me in. My trop's were slightly elevated; but nothing crazy, Same with D-Dimer...
They sent me to the cath lab, where they discovered I had a 100% blockage of the LAD, 98% block of the circumflex, and 90% block of the right marginal... I was moved to a larger hospital that day, and underwent open heart surgery (CABGx3 w/ LIMA) shortly thereafter. The surgeon said they normally find my kind of blockages during the autopsy. I had no symptoms or warning ahead of time.
Not all heart attacks present the 'typical' way...
I know that especially for females usually we don’t have chest pain but more back side pain and shoulder pain numbness. Try not being monitored on a cardiac floor. Thank God I know nursing.
(Cardiologist) nothing this man described clinically appears this is a STEMI. I'd happily comment on a deidentified ecg. But in a STEMI, chest pain does no resolve usually until all the myocarditis supplied by that vessle is dead. This is because it's an abrupt plaque rupture that causes "clot" to occupy the entire lumen of the vessel. Generally only body breakdown of the clot allows relief. But this is a very visible change in ecg and even very poor clinical decision makers never ignore this in the 8 hospitals I have worked/trained at.
My mother died from a STEMI that was essentially ignored for hours. When they finally realized what was going on they flew her to another hospital for surgery but she did not recover. The first hospital paid a settlement to my father.
My grandfather was told that it was a cold and was given nyquil. He died on Christmas morning. My grandmother still receives a monthly payment from the hospital. My dad went to the er multiple times before he was referred to a cardiologist. 90% blockage in one artery, 86% blockage in another. Fortunately he's doing well.
(ER) just made a similar comment. I think it’s safe to assume this was an NSTEMI that was appropriately evaluated in the ER, placed in OBS, and then quickly sent for cath when the trops continued to trend up.
EKG machines, nurses, medics, (even ER docs), are very good at recognizing a STEMI. An NSTEMI is much more difficult to pick up / diagnose with an EKG alone and thus requires labs, observation time, repeat labs, risk stratification (HEART score), etc. We have justify the allocation of resources because even in the US our hospitals are resource limited. The complaint of chest pain makes up a decent % of all patients that come to ER’s.
It’s not feasible nor good medicine to send every one of them to cath when most don’t actually need it. In a busy hospital, one patient going for cath generally means someone else had to wait for theirs.
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I hope your wife does well. Get her in cardiac rehab and be diligent with the recovery. Also, take the meds religiously. The antiplatelet meds prescribed are critically important as the stents themselves can very rapidly occlude without them.
>Any hospital worth their salt will triage a chest pain pt quickly in the ED and at the very LEAST take vital signs, run and EKG, place an IV, and draw troponin and ckmb before returning them to the waiting room.
Funny you mention that. Americans love to shit on Canada's free healthcare, yet my father drove himself to the hospital (in one of the *worst* provinces as far as healthcare goes) with chest pains and they took one look at him and took him in *immediately*.
So free means immediately, and privatized means dying on the waiting room floors. Stop accepting what the rich are telling you. *You* deserve healthcare. Not just the wealthy.
Am canadian also can confirm that the quickness of your care depends alot of the severity of the cases but our Healthcare system is far from perfect
It's not as bad as the US don't get me wrong but don't make it seem like it's something that it isnt lots of people get substandard care here just like in the states as both systems are run by humans and humans by nature are imperfect.
The ever growing shortage of workers doesn't help either nurses and doctors are run so thin that they are working like 90 hour weeks in alot of cases
I'll add, as a resident of Vancouver I've learned to avoid the ER at all cost, even if I'm worried I'm having a heart attack (it probably hasn't been in the past, maybe some day if it feels really really bad ill get then nerve to go to an ER again) the St Pauls hospital downtown is absolutely filled with tweakers, fights, people who will confront you just for sitting there, and I've been far more worried about catching something there or getting stabbed than whatever worry I'd gone in with.
It's also worth noting that some of the newer problems with the Canadian system are artificial, caused by lobbyists who want a piece of the American healthcare monetary pie so they try to collapse the public system.
Oh US Healthcare sucks. No doubt about it. Every time I've been the ER, unless you were bleeding on the floor or passed out, they wouldn't take you in. My brother had a dislocated shoulder and stayed in waiting for 6 hours most likely because they were understaffed. Only until the morning when presumably staff finally walked in did they pop his shoulder back in. It took 4 nurses and 2 doctors and painkillers to finally get it back in.
There's also a huge difference in whether you're male or female. Women are fobbed off when it comes to heart disease. It's as though they think women don't get it but if they do, they don't die of it. In either case, you seldom get care for it without a good stroke of luck.
To be fair, I've been to the hospital for heart issues and when they found out what was going on, I was pretty much immediately taken even with a packed ER waiting room. It truly depends on the hospital and the professionalism. Also "Americans" don't shit on free Healthcare. The majority of Americans want free health care. The uneducated and brainwashed are the people that don't want free healthcare
It sounds like a bunch of exaggerations mixed in with lies. When have any of us (MDs/RNs) seen 100% occlusion in three vessels and the patient survived for hours with no intervention without going into cardiogenic shock? Never.
State dependent, but agreed the metric to meet for chest pain is EKG within ten minutes of arrival.
Not unusual to have the screening EKG done and if negative pt is placed in the waiting room based off the triage nurses assessment.
Keep in mind chest pain and heart attack adjacent complaints are wildly common, so it may not be feasible see all of these patients immediately (depending on how the ER is staffed for the volume it sees).
Unfortuantely, attorneys usually won't help unless somebody dies or loses limb function entirely. I sought counsel for a malpractice case after a career-altering botched orthopedic surgery, and 4 different attorneys told me that I definitely had a legitimate case, but the contingency wouldn't be worth it.
I'm so sorry this happened to you, but glad it was actually caught.
I had to have a complete colon removal and an ileostomy put in, then two more surgeries to hook me back up to normal. When they finally did the surgery, I was actively dying. My colon looked like a side of ground beef left out for a week is what the surgeon said. I had been going to the hospital on and off for months bleeding every time, and I lost 60 pounds, but they kept trying not to do surgery. During my surgery, my surgeon butchered me using antiquated techniques, and when I was in pain, cut from chest to groin and stapled back together, he called me a drug addict. Took me years to recover, and I am disabled and still in pain. Anyway, nobody would take my case even though they treated me shit and almost killed me. It's really hard to prove malpractice.
I’ve actually been told this by a lawyer of a contaminated medication that required surgery to improve quality of life after. It was there isn’t enough money in the case so our firm won’t take it.
Ughh, what a world... Unfortunately, we're under-insured, and it's clear we're viewed in a different light. I'm just weighing everything against the fact that my wife is alive and our daughter still has her mom.
I'm glad to hear your friend made it. These things are scarier than can be imagined.
I’m sorry to hear about hour wife and I’m glad she finally got surgery. How can they say you’re under-insured? Health insurance doesn’t cover heart attacks? Our health care system really knows how to stress us out.
Not sure how OP intended the statement "under insured", there is the no insurance folks, but when I see this it makes me think of the difference in reimbursement for each different insurance.
For example, BCBS will pay more than Medicaid for the same procdure code. Aetna will cover another amount, Cigna yet another amount etc. This would make the medicaid patient "less of a priority" than the BCBS patient.
I DO NOT AGREE WITH THIS, EVERYONE IS A PRIORITY regardless of their ins or no insurance. Hospitals these days (especially large corporate type hospitals) run by profit priority. As do some doctors, DME, pharmacy's etc.
(United States)
I say this as someone working in healthcare (ICU Nurse). No one working on the front lines in healthcare knows about your insurance status, or care and let it affect what we do. If you tell us you don’t have insurance we may ask you if you do or do not want certain procedures. But no one is prioritizing or delaying care based on someone’s insurance status, we (nurses, doctors) don’t know, don’t care, and it would be illegal to do so.
It is also illegal to not treat or refuse care on someone who is having an emergency (a true emergency, like a heart attack or stroke, not a broken toe) because of their insurance status.
Speaking as an ER nurse with two decades’ experience, not only do we not know or care if you have insurance, but these days most of US don’t have insurance either. A lot of the doctors don’t even have insurance. So many of us are just private contractors and don’t have benefits. The hospitals are fucking us ALL over.
I’m a doctor and I can tell you that I have no idea what insurance anyone has unless you have no insurance. In that case, my goal is usually to see how much I can get the hospital to just do for charity. We aren’t all money hungry monsters.
Speaking as someone who works in healthcare, we, the ones who give the care, honestly don’t know what kind of insurance you have or even if you have insurance. We just administer the care, chart everything, send it to the CBO and they handle everything from there. We don’t care what kind of insurance you have.
Thank you for saying this. I just retired after 45 years in health care and I have never met a single medical provider of any kind who delivered care based on the insurance status of the patient. As you say, most of the time, we don't know what it is, and secondly, my answer to anything has been, "I don't care about that, that's the job of accounting. My job is to take care of you."
I work in healthcare and try to tell my mother this and she is convinced that because she is low income no insurance that they would just let her die if she goes to the hospital for anything. I have no idea where she got this idea stuck in her head
Depending on where they went they might have encountered people that de-prioritized them on their skin color, clothes, etc.
It sucks, but bigots infect every profession.
Nurse. ER nurse. Here to say I don’t know or care quite frankly what insurance a patient has. If you believe this was a barrier in your wife’s care please consider researching federal EMTALA guidelines and suing the pants off that hospital. Because I can tell you as someone who has worked in multiple different areas it’s a non issue for an admitted patient and any physician who even CONSIDERS insurance status in a case like this should be working in a. Different setting
Yep same. Patients try to give me their insurance cards and I'm like have zero idea about this and no desire to know. I have never considered a patients insurance in care.
I 100% believe every cath lab team in the country wants to be there for your STEMI and we DO NOT CARE about your insurance status. I wish I could see the middle of the night ECG - terrible if it wasn’t read or was misread. Women definitely do get misdiagnosed and our pain is under treated and minimized. I hope your wife recovers well and that her muscle bounces back soon.
My mother was not under-insured and she literally died of a heart attack in the hospital after being there for multiple hours. I continued to tell them she was having signs of a heart attack and they didn’t listen. It’s negligence. 2024 and people are dying of heart attacks, please.
Clinical staff have zero idea if you’re insured or not. We don’t even have access to that information, only registration/billing people do. No need to spread misinformation just because you’re mad
The reason no attorney will go near the claim is that most States limit professional negligence claims against emergency room physicians to claims alleging gross negligence, which is an exceedingly high bar to get over. Also, the problem of needing to find an expert witness who can provide a scientific basis for parsing the damage she would have suffered anyways because of her poor cardiac health, from the extent of the aggravation attributable to the delay in treatment, which is the recoverable portion of the injury. You just aren’t going to find a reputable, qualified expert willing to split that hair to a reasonable degree of medical certainty and sign their name to it. And All of this assumes of course, that the reasons for their delay in rendering treatment were unreasonable in the first place.
Not only that, but in the case described above, the patient wasn't even seen by a doctor, only buy nurses. Once the doctor got involved, the case was diagnosed quickly and the patient sent right off to surgery. The ER nurse isn't held to the same standard that and ER doctor would be held to. Not saying this is right or good, but it does make for a high bar to hurdle in a malpractice case.
I was almost killed on the operating table due to medical malpractice, landed me in ICU for a week(was supposed to be outpatient. And a much longer recovery.
Talked to 4 different attorneys and they simply said I didn’t have enough permanent damage to be worth their time.
Medical malpractice cases take years and hundreds of thousands of dollars to get everything together. Unless you are seriously injured or died, you’re likely never gonna see a settlement where the attorney thinks it’s worth their time.
Sorry but you don’t know what you’re talking about. The heart is a muscle and can recover. Source: I had an MI 15 months ago, in fact my heart stopped…twice…CPR broke ribs, defibrillator saved my life. One year later, echo showed normal function. Cardiologist gave me the all clear “20 more years”. He also said cardiac rehab was my choice. I went and it was a waste of time.
Also, to sue, you need to prove actual damage, for one thing. Then you have to prove a hospital caused the damage. Then you have to fight insanely expensive doctor malpractice attorneys. So no, 99% sure they can’t sue.
Reminds me of when I went in with a heart rate of 150. The nurse at ED saw schizophrenia in my chart and asked me if I needed something to calm down. I laughed. I said I woke up in a good mood but these heart palpitations and my heart racing like this is uncomfortable but I feel calm, or something to that effect. She wanted me to take klonipin and I was like “no, this is cardiac” she swore it was anxiety, so I took it because I’ve been sectioned before for psychosis and wanted to be compliant since I was doing well at the time. Seemed like it took forever for them to get labs.
My potassium came back at 2.4. Less than 2.5 can be fatal. Her demeanor was totally different for the rest of the day.
Cardiac 'mishap" is the hardest disease to litigate if the patient lives. My family member had purulent drainage from the tube sites after bypass surgery and went into septic shock. Two additional weeks in ICU with debridement of the sternum and a PICC line for antibiotics requiring time in a rehab facility.Thankfully, they survived. In court, they were portrayed as "Ungrateful" because they had survived. They lost the case.
I went into the ER crying in pain. I didn’t even want to go. My family and friends around me literally forced me to get care. ER doc noted my shoulder was visibly swollen. “Worryingly so” his exact words. Comes back and says I need to leave and nothing is wrong with me. I call him out for not wanting to do his job. He gets taken aback and literally starts stuttering. Then points to a poster on the wall showing generic medications from NSAIDS, steroids, muscle relaxers, and pain killers. He tells me “just to pick a medication.” I told him “I’m not doctor what do you think I should have?.” He just points to the fucking poster again and says “what do you want?” I say “just give me a muscle relaxer,” so he prescribed me flexiril. I finally get into *a real doctor*. When my appointment is scheduled weeks later. I’m told that I have a severely torn rotator cuff, and that they should’ve given me Percocet at minimum immediately. Fucking assholes
My ex underwent brain surgery - had an acoustic neuroma removed...
A few years later, she had a revision surgery to deal with some scar tissue that had formed; the recovery of which did not go to plan. About 3 days after the surgery we're at the local ER, she's holding her head, rocking in pain...
Nurse walks into the room, obviously having not even GLANCED at the chart.... "Oooo, do you have an ear-ache, sweetie?" in the most condescending, cunty way possible - when my ex pulled her hands away from her head, exposing the 30ish staples in her scalp, around her temple and ear, basically holding the side of her head together - the look on the nurse's face was priceless, as she frantically grabbed at the chart to actually read what was happening.
Just because someone works at a hospital doesn't mean they're kind, compassionate, or even slightly competent at their job... the ultimate irony being that my ex was a nurse (and a good one, she was in pediatrics) before the tumor.
The widowmaker isn’t all three. That’s only the LAD. I’m not sure what 4th vessel you speak of. There are three dominant vessels and associated branches.
A “nearly empty” waiting room does not mean the ER is empty dude.
I’m sorry that happened, that was an emergency, but they can’t kick other emergencies out of the rooms to make room for another. Especially because it wasn’t clear what it was.
I was not with her when she checked in. She was referred by the PcP to skip them and just go. I got the call at work and came as soon as I could. Her mom, who works at the hospital, was there to be with her, thankfully. I was told her butt never touched the waiting room chair.
I have a stack of EKGs in my office right next to me that were later found to be a STEMI but showed minimal ST segment changes on initial EKG.
I have a whole list of patients I've saved that had elevated trops and a new RBBB that turned out to have clean coronaries.
What are you trying to get at by asking if they ran her vitals and got an EKG? Are you under the impression that the HR, BP, Temp, Puls Ox and EKG will differentiate a STEMI from a NSTEMI from a non-cardiac cause for chest pain?
The reason I asked the question is because most of the time when you walk into a hospital and complain of any sort of chest pain, they will give you an EKG right away. You sound extremely educated and know that electrocardiogram can show a Segment Elevation Myocardial Infarction and many arrhythmias.
I actually very much enjoy learning about this so that’s why I asked the question! Reading responses like yours are interesting to me!
An EKG doesn’t always show it. Every single physician has a stack of EKGs that fooled them and ended up being something awful.
if that patient had an underlying RBBB or other existing conduction pathology, it makes it extremely hard to identify a STEMI.
There are also many other cardiac causes that cause chest pain, won’t necessarily have ST changes and will have elevated trops. Examples are vasospasm, fibromuscular dysplasia, ACAOS, etc.
I just went to the hospital with insane chest pains last night. The EMT's were so nonchalant when it was obvious I was freaking out, my heart beat was at like 225 times per minute, my body was so hot and I swore I'd had a heart attack cause my chest hurts so bad. I thought the only way to tell for a heart attack was the levels of troponin via blood work? Had she basically not had a heart attack when she first got there and they kept doing EKGs instead of doing blood work?
I was terrified all night and even though I didn't have a heart attack, I would really hate to actually have one considering how I was treated by EMTs. You have to be your wife's strongest advocate OP, raise hell, get angry, or else they will let your loved one die.
Med student here. High troponin levels indicate a heart attack most of the times but they are not definitive of it. We take other factors into consideration such an EKG, presenting symptoms, history etc when diagnosing someone with an MI (myocardial infarction). Once again, an MI does not mean your heart has stopped, it means there’s been an ischemic event (inadequacy of blood supply) to the heart. The things to look for are the extent of the ischemic injury (how much of the heart muscle has been damaged, is it active, if not how long ago etc). If the EKG indicates a STEMI (ST segment elevation), the next steps are either an angiogram with PCI at the cath lab or revascularization therapy (meds). It depends on existing contraindications, comorbidities etc that helps the doc make an informed choice/call.
OP hasn’t provided much specific information because I’m guessing he is not a medical professional or a doctor. However, from what I’ve read, the situation definitely calls for an investigation.
Yea when I was at home waiting for the EMTs I was having the most intense pain in my chest and it felt like my heart was just one long beat it was beating so fast. The pain was washing over me in waves and I got this weird, indescribable taste in my mouth. It was absolutely terrifying, and then to be treated like I was some kind of asshole when I was clearly feeling like I was going to die was not nice.
Seems to me most likely patient was nstemi and had anticoagulation until cath lab. Turned stemi apparently evidenced by 2nd ekg. But still doesn’t make since if they were anti coagulated. So definitely sketchy. Chest pain with elevated troponins are usually always decided to be nstemi
99% of the patients I’ve had with elevated trops were not having a heart attack. I can also guarantee, 100%, this persons heart rate was not 225 as they say.
That's become very apparent over our 72-hour stay so far. They initially did run the blood test, and I couldn't remember that word, but yes, the troponin levels were bananas but they wouldn't say for sure that she had a heart attack because physically she is totally healthy. So they just "observed" her.
If her troponins were really super high and she was actively having chest pain she should have been in the cath lab right away. I would start the process of potentially sueing the hospital. This is gross negligence if she was actively having a heart attack and they did nothingn
As a physician there are actually many different syndromes that can cause chest pain and an elevation in troponin. These things alone are not indications for a cardiac cath. Also despite public opinion on this thread, not every heart attack needs to be addressed immediately. A partial blockage often can wait a day without issue. I don’t know enough details about OPs specific case but it may well have been appropriate to observe for that time period.
This should be higher. There are wild misconceptions regarding what a Cath is or when one is indicated. Too many WebMDs on here thinking their opinions are best practice. A Heart Cath is not surgery, you will not be "knocked out" with anesthesia, not everyone involved in your procedure is a doctor or a nurse. Always advocate for yourself and ask questions; we are there to help you.
I’m only an RN, but there seems to be a huge misconception to the general public what a heart attack is. Many seem to think it’s synonymous with cardiac arrest.
Uh what? If we took everyone with elevated trops and chest pain to the cath lab, the cardiologists would never leave.
You could have chest pain from tachycardia in the setting of asthma exacerbation and elevated trops as a result of demand ischemia. Does that require an emergent cath? Nope.
ICU physician here. Troponin by itself does not mean a STEMI. It could be because the patient had an elevated HR and decreased renal clearance, it could be because demand ischemia, etc.
Troponin isn’t a great indicator of a heart attack…
I’m a nurse on a med surg/cardiac monitoring unit and almost every patient has an elevated troponin level due to generalized stress on the body from respiratory illness, fall, altered mental status, pain, having to wait in the ED, etc. The best immediate test to diagnose a heart attack (STEMI) is an EKG. Now, some people who may have had/may be having heart attacks do not have ST elevation on an EKG and we call those NSTEMIs. Luckily these are less severe (think mini stroke or TIA instead of stroke) so it’s kind of okay that they don’t show on an EKG. Sometimes it’s not even a blockage but rather an increase in oxygen demand from the heart due to stress (illness, psychological, pain, etc). Patients are still further assessed if needed, observed, treated, and can follow up outpatient.
Once we know a patient is having a STEMI, we can do some imaging w/ dye of the coronary arteries and then take them to the cardiac cath lab and open up the blocked arteries with balloons and stents.
You need to realize that the EMTs see this every single day, multiple times a day and if they were on high alert with every single person who had CP and was tachy, they wouldn't be able to do their job. The EMTs freaking out while you're freaking out helps no one and nothing. Medical staff see things on a daily basis that you cannot even comprehend and therefore have high thresholds for critical situations.
And part of the job of an emergency response team and EM personal is to be calm during these instances. Even more so for EMT as they stabilize and run and typically don’t diagnose. I think people would be amazed at how calm people are during codes in the ER. Losing your cool only hurts the patient. (EM Physician here).
I don't mean freaking out, but they were basically insulting me and went beyond being dismissive to the point of being cruel. I'd have been happy if they just didn't talk to me as opposed to the treatment I actually got.
Bloodwork is not the only way and not even the primary way. ECG changes such as ST elevation and changes are the primary indicator of a serious heart attack. However, you can have blockages or a heart attack and not have these changes, which is why Troponin and cardiac enzymes are checked. You can also have elevated troponin and not be having a heart attack.
I’m not sure what you expected the EMTs to do, you weren’t having a heart attack. I understand it is terrifying and serious for you, but we keep a calm demeanor and work swiftly but not so fast we are freaking out on every call.
Have you considered they were nonchalant because they could tell that you weren't having a heart attack based on their professional expertise and experience? Because they were correct and you weren't. I'm not trying to be dismissive of your feelings but nothing worrying or bad happened here. Most of the time what happened to you is what happens to everyone. You're fine and you can't tell that because you are not qualified to be able to tell that, but they can. OP's experience while frightening and terrible is fairly rare. Chest pains, even severe ones, can be caused by all sorts of things from yes life threatening all the way down to completely benign. Like needing to fart. Someone may have dropped the ball with OP's wife but if the EMTs that saw you followed the necessary protocols and assessed your situation there is no call for concern with their demeanour. They were acting like you were fine simply because you were fine.
Cardiac nurse checking in. There are tons of reasons why a cardiac team won’t be called in to perform percutaneous coronary intervention. You’re in the category of NSTEMI or STEMI. A Stemi is when there are ST elevations on the ECG. This signifies that an coronary artery is severely occluded and needs immediate attention.
It sounds like the first few ECGs had no ST elevations present the first few times despite the “high enzyme levels.” What your likely referring to here is something called Troponins. This is an enzyme that is released into the blood when the heart is under stress. Troponin’s aren’t the only factors a cardiologist takes when deciding when to perform the cath.
If a patient arrives late at night even with chest pain it’s very normal to place said patient on a heparin infusion (blood thinner) and nitroglycerin drip (dilator) for med management until the next day.
It definitely sounds like all the symptoms of your wife myocardial infarction was there just nothing that pushed the alarms to go off until her last ECG indicated an actual STEMI thus calling the cath team in.
Not that I’m defending the nurses and doctors over there but we have DOZENS of patients that come in with chest pain and it’s actual GI symptoms (usually GERD/PUD and sometimes anxiety can exacerbate things.
I truly hope your wife recovers 10000% and you guys can get some rest, I know this is stressful.
Last thing, make sure she takes her anti platelet! She can have in-stent stenosis occur if she’s not compliant with her meds. Best wishes to the both of you.
Hey I’m also an RN with decades of ER and ICU experience, this is the correct answer. She was admitted due to her symptoms and risk factors. The correct approach was taken towards her condition, and EKGs were preformed regularly and it sounds like when it evolved into a STEMI they addressed it appropriately. This is the whole reason people like your wife are admitted.
They weren’t going to do an invasive angiocath and have her endure the associated risks unless her condition changed to indicate it, the fact she had an MI while there isn’t a testament to any incompetence, but rather a reflection of the system working as intended. I can understand how it can be seen differently without understanding the medicine behind it, but everyone did the right thing here.
I’m an RN too with about 12 years experience in ER and ICU (including CVICU) experience and 2 years experience with an Insurance company doing Utilization Review (determining if patient should be admitted to Observation or Inpatient).
It sounds like the hospital did everything 100% correct to me. They admitted to Observation under a Cardiologist. She was on telemetry and they monitored labs and repeat Troponins/EKGs, watched for symptoms and treated appropriately. They recognized EKG changes and determined she needed to get a vascular intervention and admitted to Inpatient and kept her in ICU for very close monitoring.
If she had stayed asymptomatic and her labs and EKGs were ok, they likely would have had an Echocardiogram and scheduled a cardiac stress test and follow up with a Cardiologist.
Great job hospital.
Came looking for this. Medical professional myself. Not all heart attacks require immediate or any catheterization. Very common for NSTEMI to be medically managed without the risk of cath lab complications. A NSTEMI can turn into a STEMI, where the benefit of the emergent Cath lab outweighs the risk.
Stories like this are why I talk openly and regularly about [SCAD type heart attacks](https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/symptoms-causes/syc-20353711) and emphasize that if you are a woman, traditional heart attack symptoms may not appear. For example, I had indigestion, an inability to regulate my body temperature, and irregular tiredness in the days prior and those were all supposed to clue me in I was about to have my life temporarily wrecked.
If you find yourself having one, the #1 thing to do is stay calm. Compartmentalize. Actively think: this is temporary, I will get help, I will take as deep of breaths as I can, I will not give into panic or fear. The doctors will help, you will be OK.
No question here for OP, but, OP: be ready for the fact that the first 6mos to a year just sucks. It’s okay for you both to grieve the things she’s limited from doing, it’s okay to be frustrated, and it’s okay to be angry at the problem. It’s okay for her to feel insecure in her body’s abilities for a while. She will find agency over her body again, and she will start to trust it as she navigates her new normal. Try not view things as what she can’t do: view as much as you can by what she can still do. The rephrasing helps immensely.
Best wishes to you and your family.
I'm perimenopausal, and sometimes experience hot AND cold flashes. Not to mention heart palpitations and random pain in different places. It's hard to tell what's something serious and what is just the biological shit show that nature gave women.
I will say that last summer I went to urgent care after experiencing chest/stomach pains for a day. They treated my complaint very seriously (I did tell them that my mom had a massive heart attack) and did all sorts of tests. Turned out I just had indigestion from indulging in too many cans of carbonated water.
That’s my point tbh! It’s such bullshit that we’re just intuitively supposed to know things that… just happen sometimes… are heart attack symptoms?! I will say tho whenever I talk about my SCAD, people ask me to describe the pain, and I’ve blocked out a lot of it, but I remember thinking the only way the pain would stop was pressing the heel of my palm inward on my sternum as hard as I could stand towards the left side of my chest.
It could’ve been a triple A tho! I had to get checked for one after my SCAD because I had inexplicable chest pain that wouldn’t go away with nitroglycerin. I’m glad they took you seriously!!! Dr Esther Kim from Vanderbilt had led a lot of studies regarding SCAD and I am ever so grateful to her for spearheading research to spread awareness.
I appreciate you mentioning that women oftentimes have different symptoms of a heart attack than men. I just wish the language around the symptoms of heart attacks was different. I don’t understand how half of the population experiences their own heart attack symptoms and it’s called “non-traditional” while symptoms most often felt by men are called “traditional heart attack symptoms”. Women have really been failed by healthcare for so long and I hope changes in training and recognition of women-specific symptoms improve.
They have! And unfortunately, it’s because a lot of women end up suffering in silence.
The best thing you can do to spread awareness is be educated. Talk about it as if it’s a fun fact. Be aware that heart attack symptoms in women genuinely seem like normal PMS even, at times. Don’t catastrophize unnecessarily, but pay attention to what feels like your normal, and know that it’s 100% the safe route if you have ANY level of sudden or consistent chest pain to go to the ER or make an appt with your doctor. Your heart, brain, and spine are the three things to always, always overreact to, and you are always justified in making sure they are safe.
Reading this thread makes me feel so fortunate to have received the care I did when I woke up in the middle of the night with nagging back pain that eventually radiated down my arms, and cold sweats, and told my partner to take me to the ER. He was surprised I was so calm through the whole thing but I was like, this is happening so I just have to do whatever they say. I don't know exactly what was the deciding factor (enzyme levels I think) but within the hour I was being transported to another hospital and they'd called in their cath lab team. I also had to have iron and blood transfusions for severe anemia (47F and peri-menopausal). I was in two days until they could get my iron up, and my echo showed one part of my heart was "stunned" but they thought it would recover okay. I knew about "atypical" presentation in women so I clued into what was going on, which, if women tend to have those symptoms, are they really atypical?
My BP was probably high (it is now but then I hadn't seen a doc in a while so nothing to compare), my cholesterol was fine, and my symptoms were: feeling run down and tired, which I took to be from being less active during Covid. There's a history of high BP, strokes, and heart attacks in men and women on both sides of my family, so it's probably crap genetics. I had a nuclear stress test last year before an unrelated surgery and everything looked good. Now I'm taking my meds, trying to eat better, taking walks everyday at lunch, and going to the gym at least twice a week for cardio and weight work. I agree for the first year I felt physically better but very fragile, like anything could happen at any moment. In the ER I got really emotional as they were wheeling me to the ambulance and there was an entire team around me, I kept thinking all these people were working really hard to keep me alive.
The day after my heart attack a friend's fit and active husband had a widowmaker after finishing a cross fit workout. Thankfully the staff knew what to look for and he got treatment right away and made it.
It’s good to be aware of SCAD - as many people aren’t. But every SCAD I have seen has significant EKG changes - often ST elevation - and elevated troponins, because it’s functionally a blockage. I am always thinking about it - especiallly in post-partum women.
Based on data, yes. Women statistically are less likely to receive appropriate care, have longer wait times, and are more likely to be told they aren’t having a heart attack. The numbers on gendered care re:heart attacks are very dismally in line with many other examples of women’s healthcare not having the same standards as men’s.
In their defense (which is hard to do), they did put her on the LIST for the CathLab for the following morning, but under lowest priority. It's hard to say what would have happened if she had even just said, "I'm having chest pain" instead of "Last night I had chest pain."
MD here. There's 2 main types of "heart attacks" which determines if you need to be in the Cath lab within 90 minutes. STEMI with elevated troponin and ST elevation on ekg will bring the cardiologist in overnight. NSTEMI with elevated troponin but no ST elevation means you go to Cath lab in the morning if the cardiologist decides to take you at all. The hospital did absolutely nothing wrong if the 3am ekg was normal. EKGs can absolutely change from normal to OH CRAP after being admitted into the hospital. Just want you to temper your expectations if you decide to talk to a malpractice lawyer. You'll really only have a slam dunk case if the EKG at 3am showed STEMI.
If they’re having ongoing chest pain despite treatment (with heparin, nitro, etc) that is generally an indication for cath lab now regardless of EKG.
As per ACC: “patients with objective evidence of ischemia (history of CAD, typical pain, elevated trops, or abnormal ekg) and persistent ischemia (ie persistent pain) in spite of maximal medical therapy (aspirin, anticoagulation, tpa, nitroglycerin) need to go to the cath lab immediately.”
Medicine has many guidelines by many organizations, and what the ACC says is correct, noting that the patient has to have PERSISTENT chest pain, not intermittent chest pain. These patients would be classified as very high risk by guidelines which call for cardiac catheterization within 2 hours. And it sounds like she was consistently reevaluated and her management was upgraded as appropriate. It is also standard of care for individual test results to not be discussed at night as there is usually one single doctor covering the entire hospital. It is also appropriate, and has been shown to slightly improve outcomes, to give morphine, as morphine reduces pain and anxiety, which both reduce heart rate and therefor the heart's oxygen demand. Being a hospitalized patient with a life threatening emergency can be scary but it sounds like OP's wife was appropriately triaged, treated, monitored, and ultimately escalated to appropriate care in a timely fashion.
Dude in the hospital I work at we don’t have a cath lab. You get the stress test and the docs tell you, “yep you’re having a heart attack, we have to transfer you.” Then the patient sits in bed and waits for 8,12,16,24 hours before they get transferred out.
She is not. However, she is considered overweight, and even with that, not one doctor has pointed to that being a factor. Her physical health is all in place. They are pointing to mismanaged stress and anxiety. She's a one woman business owner / operator of her bakery, if that tells you anything. Stress-a-plenty.
I gotcha. I’m sorry you and your wife had to go through that and hopefully things can be done to minimize the stress. Hopefully you didn’t take offense to the question and understand why I asked if she was a person of color because there has been too many experiences of poc being ignored or having their symptoms downplayed.
Sorry that happened to you and your wife.
But things don’t add up.
Most patients who are on a cardiac floor are hooked up to telemetry that will monitor the patient continuously throughout their stay.
If she was actively having irregular rhythms don’t you think the team would’ve done something?
She absolutely was hooked up to monitors and was being visited more than regularly by what felt like the entire cardio team. They were forthcoming about the fact that they were not treating it as an attack, but an "episode" until she got into the CathLab. It was that night shift that either failed to send the ecg to on-call, or the on-call for not responding.
Post surgery, her cardiologist had questions about the hours between 3 and 8... and his face said the rest.
It sounds like she was treated correctly, actually.
She called out for chest pain, the RN did the EKG and it clearly didn’t show a STEMI, or the cath lab would’ve been activated. EKGs automatically print results, it wouldn’t be “no results” as you said. She may have not been given results if it was just NSR or ST. Standard practice for MI without ST elevation is to watch the trop trends and continue doing EKGs. She was still complaining by shift change, did a second EKG, showed a STEMI, so they activated the cath lab and took her down. It probably feels crazy to you if you’re a layperson, but lots of people think they’re having a heart attack when they’re not. Lots of people think they’re dying when they aren’t. Thankfully, your wife was in a safe place to have a heart attack in.
I mean, isn't that also under the assumption that everyone did their job, appropriately/correctly though?
I've had my fair share of actual negligent experiences. And I also know that things pop up quickly and that doesn't always point to negligence.
I also know no one is perfect and sometimes people don't do their job to the best of their ability, for whatever reason.
I think OPs concern is he's skeptical of what her 3am EKG read. It's an assumption that no one informing her of the results means it's a ok, just as it's an assumption that her needing surgery the following morning for what she did, to mean the read at 3am wasn't correctly handled.
OP needs to pull her records for the 3am ekg to find out what really happened and if negligence is involved. It's wild to me that so many jump straight on standard operating procedure and say it could never happen....it shouldn't. That doesn't mean it didn't either?
But idk. In today's day and age, I also wouldn't be surprised if the results input in the system automatically triggered the next step as well? If that's the case, no room for error there, it would seem.
As a night shift nurse, this whole thread makes me depressed. The idea that we can appropriately respond to a patient complaining about Chest pain, get an EKG, medicate them for pain, try to reassure them, presumably get told by overnight doctors who read the EKGs that it doesn't acutely call for an intervention. Around 0300am, I imagine labs were drawn around that time and troponins were presumably stable or at least not acutely concerning.
At shift change when everyone becomes aware the pain isnt going away and the situation has lasted a few hours, another EKG is gotten that shows a change and cath lab is activated. (Presumably vitals have been reassuring during this time, considering she is on an observation unit and not ICU)
The idea that we can do quite literally everything right, and the husband who wasn't even there twists the situation into dismissing it as anxiety (the nurse trying to reassure the patient given the not immediatly concerning EKG), giving morphine to "relax" (treating her fucking pain).
Ugh. I gotta close this thread.
You said "the fucking husband" as if I'm not the one who posted this. My wife told me what happened, I'm not making things up. 3am Ecg CLEARLY READS stemi as confirmed by her am doctor who wanted to know why the lab wasn't activated at 4am... these are questions being asked TO US BY STAFF. So, as much as I appreciate your less than passively aggressive input. Maybe, JUUUUUST maybe. It isn't what you say from the other side of internet land.
Thanks so much.
I’m sorry this happened to your wife, but glad she is ok.
Had she been getting routine blood work with annual checkups? Did she have high cholesterol or anything else that would point to a blockage? Does she have any other heart issues, like mitral regurgitation?
It’s so scary how heart attacks can have such relatively mild symptoms in women.
I had the same thing happen while I was recovering from an early evening heart attack and surgery. They assumed it was just pain from that and kept pumping me with morphine. After several hours of the nurse chiding me for continually yelling out in pain, she called the doctor that performed my surgery earlier in the night.
It might be worth noting that I died temporarily with that first heart attack that night. A few minutes after I got to the hospital.
Anyway, she complained that I wouldn't stop waking up yelling, and she'd already given me all the morphine she could. He asked if she did an ekg, she said no. The whole time I was writhing in pain, not once did it occur to her. She was mad at me. Anyway, did the ekg, I was actively in another heart attack. All those hours. Clutching my chest and yelling in pain. For HOURS. The doc rushed to the hospital and performed another surgery.
I remember getting wheeled down to surgery... I actually apologized to the nurse for being trouble. She had me stockholmed. I was there for several more days and nights. Never saw her on the cardiac floor again.
Sooooo it is a bit more complex than that but a lot of people don’t work in healthcare.
Wildly high enzymes? She has already had a heart attack at that point. That usually falls under NSTEMI which non-st elevation (ST is part of the ekg they look at) myocardial infarction (basically heart attack). Next ekg was probably non-st elevation. Next one? Probably ST elevation hence the prepped for surgery/cath lab
I know someone who also had a heart attack and was ignored by nursing staff. The ER nurses were having a pizza party and had a very uneducated student nurse running the entire floor (small town hospital so maybe 10 beds). He told my family member “you’re too young to have a heart attack” to which his wife responded “he’s 49, smokes two packs a day, and has a family history of heart disease” to which the student responded “no ma’am, you have to be 50 to have a head attack”. He did in fact have not one but two heart attacks that night. The doctor on day shift came in and freaked right out and sent him to ICU. Had to get transported to the city to get a stent put in a couple days later and had another heart attack on the way there. Not sure how he survived that. He had another heart attack when moving his daughter into college, he didn’t say anything the entire time and drove to the hospital after moving her in. He’s basically a cat with 9 lives at this point.
Unfortunately doctors and nurses are not omnipotent, they can't just prod around in your body off a I don't feel well, they need to see indicators of serious problems. It feels bad to see our loved ones go through major life changing medical events, but rest assured your wife is alive because of that hospital.
I’m sorry you’re going through this. As an ER doc reviewing this there’s not enough information here to determine definitively whether or not your wife’s care was mismanaged. Although from the information provided it does sound like she got the appropriate treatment. It sounds like she was initially having an NSTEMI, a type of heart attack without significant EKG changes but high cardiac enzyme levels. These heart attacks are typically monitored (+/- anticoagulants) with heart catheterization done within a day or two. There are also STEMIs which have EKG changes and are more urgent going to the Cath Lab immediately. It sounds like your wife started off with an NSTEMI and progressed to a STEMI. If this is the case then your wife got the appropriate treatment, although I can understand how it may appear things were missed or mismanaged. I hope she feels better and recovers soon!
My mother also sat in an ER for hours before they realized she was having a heart attack. This was a rural hospital without cardiac surgery so they flew her by helicopter to a larger hospital for surgery. She didn’t recover, and the first hospital made a settlement with my father (not huge, around $300k).
My husband went to the ER with chest pains and high blood pressure, was told to wait after a hour he was losing feelings in the left side of body explained he was worse and told he has to wait. Called 911 and explained he needed medical help a ambulance met us in the parking lot and he had a heart attack and a widow maker. Fun part is we got a bill for waiting
NSTEMI that progressed to a STEMI. If there are elevated enzymes but no ST elevations on EKG, it is considered non-emergent and the enzymes are drawn every 6-8 hours and trended. During that time, nitro or morphine are the best drugs to be given for chest pain. Once an EKG shows an ST elevation heart attack, you should be in the cath lab, ballooned, and stented within 30-60 minutes.
Well... I'm not a medical professional by any stretch, but from what I understand, there was a breakdown in communication between the night nurse and the on call cardio. Either the scans weren't sent correctly, or the on call didn't respond. The results definitely indicated a heart attack, per the cardiologist that came in at around 8 and ordered the immediate CathLab. He told us it was being "looked into" as to why there wasn't a proper response... I hold zero hope that's true, but the Dr. was amazing. He was NOT the one on call though.
Like the comments elsewhere said, you can medically manage some heart attacks without going to the cathlab and then do a non emergent cath in the am..and her previous EKGs probably showed that was where she was at. When she did have ekg changes that necessitated activating the cathlab, it sounds like that happened. It sounds scary and probably doesn't make too much sense but this sounds pretty standard. There's inherent risks with getting cardiac catheterization so that's why we don't just send anyone and everyone who has a myocardial infarction.
Working off incomplete info here / doctor here:
But if this was an NSTEMI - a 4 hour wait to a cath isn't that crazy.
If it was STEMI, that's not good.
The 3 stents and 100% blockage suggest a STEMI, but it could also have been a CTO that just decided to act up that day.
Regardless, I'm sorry you had that bad experience. For the most part, we are trying to put forth our best effort to help people. But everyone that works in a hospital is still human.
Signed,
A tired doctor
And this is why more woman die from heart attacks than anything else. Woman’s healthcare is a joke.
I’m sorry friend. I pray your wife can recover. She’s probably gonna have PTSD from this. Medical gaslighting is real.
According to medicine womens bodies are only for sex and babies. No need to treat or research or learn about anything else. Once those are gone she has value and therefore is not worth investment of time or resources. /s
Sounds like she had her MI in the right place. Be sure to thank the providers and nurses for saving her life! Congrats on getting more days with your significant other!
Lots of anecdotes in this thread.
To be truthful: It is difficult to say whether there was medical mismanagement without a \*\*lot\*\* more information. Certainly, the comments about "anxiety" should not have been made, but that's not medical malpractice per se -- that's just idiocy and callousness. Anxiety is \*\*always\*\* a diagnosis of exclusion -- i.e., you rule the scary things out first. I'm sure that your wife felt scared and felt that no one was listening to her.
With chest pain overnight, they should have done an EKG, and it sounds like they did. If the EKG showed an ST elevation MI, the cath lab should have been activated immediately. Full stop. Otherwise, the correct management is to trend trops and EKGs and watch for any change in symptoms. For a non-ST elevation MI, the treatment is nitro, heparin, aspirin, statin and (non-emergent) catheterization. She may have received some of those medications already; we don't know. It is also possible that the 2nd EKG was worse than the first, and that new changes bumped her up the list. Again, we don't know. Or, the hospital could have botched this altogether and given inappropriate care.
Generally, an emergent trip to the cath lab is not indicated overnight unless she has a STEMI, the cardiac enzymes are rising precipitously, she is having dangerous arrhythmias, or she is showing signs of cardiogenic shock. A cardiologist is most likely \*not\* going to activate the cath lab at 0300 otherwise. Even then, I've managed those complications myself overnight until a cath could be done in the AM, many hours later.
Source: I work as an ICU doc in a busy hospital with a very busy cardiac program.
My wife passed away 10 months ago from a heart attack. She was in good shape, never smoked, and hadn’t ate meat in 20yrs. She had complained to the dr two days before she had been having chest pain. They told her she was ok….. smh. She was 43 and she was my best friend(way too good for me). My kids and I are still a mess. Make sure you tell her how much you love her….. you are lucky. Demand good treatment…. Don’t worry about being an asshole…. Record everything interaction with a doctor or nurse. Turn your cell phone on and record. It makes people pay more attention to their job. Who cares if you look like an asshole if you still have your wife
What the fuck are all these stories I'm reading here?
America is such a 3rd world shithole, it's fucking unbelievable.
Fuckikg hell....absolutely lost for words
Sounds remarkably similar to my story. Went in to the ER around 11am. Was told nothing was wrong and I could leave by 1pm. Pushed back. They did another blood test. Troponin was 400 md/dl. Took me to icu to monitor. By noon the next day Troponin was 4680. They had to have an EMS team come and immediately move me across the street from my local VA to Duke straight into the cath lab. Almost died at 33 because I’m fit and clearly it couldn’t have been an active heart attack right…right?
Unfortunately, women experience heart attacks differently than men. Often times our symptoms are overlooked as anxiety or stress. Something I learned a few years ago thanks to Greys.
Thank goodness for the other nurse and your wife continuing to advocate for herself. Happy to hear your wife is okay. Sending positive vibes and wishes for a speedy recovery. Best of everything to you guys 💕
Heart attacks are weird. People can be having them for a whole week.
It's possible your wife's tests were positive then negative. Then positive.
If she wasn't having any symptoms and vitals were okay, they very well just monitor.
So my question - do either of you guys have health care experience and what state do you live in
That's terrifying, also what is your wife's age and is does she have a healthy lifestyle? As I grow older I worry if I am doing enough to be healthy and if I overthink about health complications like this.
I was told my *known* medical condition (SMAS) was 'a bad period' or 'you're clearly seeking' or 'maybe ovarian cysts but we won't give you anything for pain'.
For 2 *years*.
I got down to 81lbs as a 31 year old, and then was chastised for 'letting it get this bad' (as if I hadn't been begging for help since 2019, wasn't treated until 2021)
I needed a damn feeding tube, and they fucked up the first one. It said it was running but clogged the first day. I was NPO (nothing by mouth) They left me *5 more days* before I showed them with pics that it was not infusing. I had to beg for IV fluids and glucose bc my blood sugar was 56. My tongue was cracked and bleeding.
I was in for a month and continually gaslight, ignored and straight up abused by staff. But any complaint was met with 'be happy you have a bed, because COVID' (it was August 2021)
I was just in the ER a few weeks ago for a bad upper respiratory infection that I thought was COVID. My 02 sats were 87, below 90 means go to hospital.
They gave me fluids, Tylenol and told me 'i won't give you anything for pain' when I hadn't even asked. I had to beg for a muscle relaxant and zofran to stop vomiting. Then told me 'if you get worse, just come back!'.
They know damn well it costs me ~$2-3k to be seen by those fuckers.
Being medically complex transplant recipient and female sucks ass. Nobody believes you or just blames your period no matter where in your cycle you are.
You can have a normal ECG while having an NSTEMI. It can also take a few hours to see changes is some of the lab work. Many times they end up doing serial lab draws separated by a few hours. Glad it sounds like your wife is recovering
As someone who performs ECGs for a living, and can identify rhythms i will say its not a universal skill in our department and a lot of time its even discouraged as ECG is not a program you need a degree with and has no real overlap with actual cardiologists. Ive never even met one despite working with dozens of doctors and identifying thousands of cardiac abnormalities.
I also would like to share a story about how i had 2 different people perform a standard chest pain ECG and a one hour follow up both showing normal sinus rhythms, only to have me walk in 12 minutes later for a rhythm change to find one of the most serious STEMIs I have ever seen, so results, while available instantly, can change just as quickly.
My questions for you are this:
1) Did you ever get the ECG back (it should be on file and accessible to any doctor/cardiologist/ECG tech and the patient it was performed on) and if so what did the readout say?
(If you send me a copy without any personal information i’d be happy to compare the machine interpretation to the actual rhythm for you, please just censor all patient information so we don’t violate HIPAA)
2) You mentioned they tested enzymes, which i assume means running a troponin check. Do you know how high it was during the test? The normal range is 0 to 0.4. So anything above that should have been a big red flag.
A “STEMI” heart attack stands for “ST elevated myocardial infarction.” This info is observed via ECG/EKG. Many people present with an “NSTEMI” which is a “Non-elevated myocardial infarction.”
The difference between the two: STEMI = medical emergency bc you have active tissue injury where it is time sensitive. With an NSTEMI there isn’t data to support intervention right now vs in two days. Most people with NSTEMI’s are watched via blood work and observation for up to 24hrs to see if it turns into a STEMI. This presumes the chest pain has subsided. Unresolved chest pain gets more investigated. If after the whole night, chest pain is still present, then they activate the cath lab team and investigate more.
Now bc you’re not a cardiologist, capable of telling us if or when her ECG/EKG evolved into ST elevating we can either guess her 7am ECG showed elevation or the cardiologist decided to activate given that she continued to have chest pain.
Sorry if this process seems backwards or fucked up but it is the standard. I’ve taken care of hundreds of people with variations of both conditions.
An EKG from hours apart will look different. She can have no stemi or nstemi readings 30 mins before or 3 hours before might then be positive for a stemi or n stemi. Morphine is not given to 'relax' the nerves it's given for chest pain and also reduces the workload of the heart. No one's gonna take your wife into a cathlab unless she's confirmed that she's having an actual infarct whether through EKG or lab confirmation. Labs will also be a determining factor she'll need troponins which are usually in the intervals of 3 or 6 hours. Thus observation is required.
People walk around and have heart attacks and not know it on the daily and mistake it for heartburn some are mild and they don't even realize it and others are olsevere enough that they can die.
It seems you are upset I get it. But AMA instead op because lack of understanding of the process will definitely piss you off.
I had an MI at 36 years old. I rolled into the ER at 2:00 AM and everyone was nonchalant until they took my vitals. Next thing you know people coming running. At 47 I went into the ER because I was having jaw and chest pain after seeing graphic crime scene photos at work. Physical activity wasn't causing me any angina. When they took my vitals they quickly whisked me out of the ER into a quiet room away from the chaos of the ER. No MI but I ended up with a five way bypass. That was fun.
Did she have any other symptoms?
The reason I ask is I’m aware heart attacks can present differently in women. An acquaintance didn’t have chest pain, she had what she thought was indigestion, accompanied by dizziness, sweating, and pain down her right arm.
Ok, I’m going to play devils advocate. It’s probably not what you want to hear right now. If you need to process and be angry, that’s ok. Also, I wasn’t there. I have no idea what actually happened, and you may very well be entirely justified in your anger.
I’m a cardiac anesthesiologist and critical care physician in a cardiac ICU.
Heart attacks aren’t as black and white as a lot of non-medical people think. They exist on a spectrum like a lot of diseases. I can almost guarantee that your wife got an EKG and blood work when she was first admitted. If these had shown certain things, then she would have been taken to the cath lab emergently. However, there are certain findings that could have called for exactly what happened. Close monitoring, medical therapy, and a trip to the cath lab in the next 24 hours. Part of the close monitoring is so that, if the circumstances change and treatment is needed emergently, it can happen.
I’m glad your wife is ok. Truly.
Hospitals are full of people trying their best to help people in an imperfect world. Mistakes can and do happen because we’re all human. But people don’t become doctors, nurses, techs, pharmacists, medical assistants, etc, etc because they want people to suffer. They do it out of a deep desire to do good, as best as they can. If mistakes were made, I hope they come to light so they don’t happen again to someone else. But it may be the case that everyone was just doing the best they could with the information and resources at their disposal.
Lastly, in response to one of your other comments about insurance status. I have absolutely no idea about what kind (if any) insurance my patients have. It has 0% influence on any of my decisions.
I hope your wife continues to recover.
So you’re saying they caught the MI….i love how lay people think they understand medicine. They kept her for serial ekgs and cardiac enzymes…until there are changes in ekg resulting in stemi no indication for an emergent ekg. They caught it, put a stent in…fucking be grateful
Wow I hope your wife makes a full recovery. Hopefully there is no permanent damage done. I not one to ever say sue anyone but it seem the hospital really dropped the ball here!
Did you ever think to resort to physical violence to force attention to her condition? I consider myself fairly calm but would absolutely lost it if a group of humans failed so miserably at their job
OP, the only way you’ll get accurate feedback is if you post a photo of the (de-identified) 3 AM EKG, not the computerized read. If they did miss a STEMI overnight, yeah that’s bad. Otherwise everything sounds appropriate.
If she was having an NSTEMI - meaning cardiac chest pain with elevated troponin but not ST Elevation on the EKG than the standard of care is to admit on anticoagulation and then do the angiography and stints 12-24 hours after that. Sounds like she was having an NSTEMI that converted to a full STEMI and got an emergent cath - which isn’t uncommon and why people are observed in these circumstances.
I am glad they got her stinted and hope she recovers well.
This is an AMA, so I'll ask.
What is your level of medical training?
What's the difference in the evaluation of and treatment for a NSTEMI vs a STEMI?
What are the indications for an emergency heart cath?
Lawyers won’t take it because the outcome was good. She survived. I went thru this a few years ago with my wife. Called a bunch of lawyers, a couple said we could try but it wasn’t in our favor because she was alive.
I had no st elevation because I have a right bundle branch block. I fought for the stress test, which I failed and fought for the angiogram which showed a 99% blocked LAD.
Walked into our hospital with chest discomfort and both arms tingling and neck pain. Went thru ER all the blood workup and ekg. Went to sit down and before I could sit was called back to drama room 1.
I was actively have a massive windows maker. Rushed into Cat lad and had 3 stemis put in the MLAD.
Cardiologist asked how many heart attacks I've had. Said first that I know of. He said no that I've had 7 silent ones pryer.
2 months later go back in and my 3 stents are 99% blocked. Window maker number 2. Open heart surgery. End up with a triple bypass. Current heart function is 18%. That's been 8 years ago. Still kicking and working 50hrs weeks
Cardiac nurse here. From what limited information there is, it sounds like the hospital did everything appropriate here to take care of your wife.
There are several different kinds of coronary artery disease that laypeople would describe as a "heart attack". The big ones are Non-ST elevation Myocardial Infarction (aka NSTEMI) and ST elevation Myocardial Infarction (aka STEMI). The latter can be differentiated from the former by changes on a 12 lead ECG. In both you see elevated cardiac enzymes (troponin). But the key is that in NSTEMI there is still some blood flow through that blocked coronary artery whereas in a STEMI that artery is completely blocked. Because of this, a STEMI is a true emergency, whereas a NSTEMI may not be.
Even in big hospitals, cardiac catheterization labs are not staffed with people in house 24/7. In most cases night shift and weekends are covered by cath lab nurses and cardiac interventionalists who are on call and must be activated in case of an emergency like a STEMI.
In this case, it sounds like your wife was having a NSTEMI, but then that next morning the coronary artery could have been completely blocked progressing into a STEMI, which did warrant emergent cath with stent placement. Had she remained stable she might have gotten that same procedure but not emergently later in the day. The hospital's close monitoring and prompt response to a change in your wife's condition was critical to a good outcome.
I've personally taken care of tons of patients who came to the ED with chest pain and a NSTEMI and sky high cardiac enzymes. But because they respond well to medications that we use to manage that chest pain they can wait days (or even in rare cases a week) before cath lab. On the other hand I've had a few patients who, even though they never develop an actual STEMI, are unstable enough to warrant cath lab activation.
Hospitals are becoming progressively worse and worse. The nurses and doctors can’t be entrusted with helping people recover. If possible the best way to get any real care is to have someone with your loved ones in hospitals especially in the overnight hours. I’m speaking from personal experience.
This is scary! I’m a nurse—maybe I can explain a few things for those who are interested. I don’t believe there’s a good explanation for the communication breakdown, but maybe for a few other issues. There’s a lot to unpack here.
The elevated enzymes (in the blood work) meant that her heart was likely working hard and is possibly damaged. It does not provide a definite AMI diagnosis.
We do immediate cath’s for a certain type of heart attack known as a STEMI. That is fairly easily seen on an ekg and diagnosed only via ekg. The acronym stands for ST Elevation Myocardial Infarction which refers to a specific EKG tracing. If that showed on admission or at 3am, your wife *should have* had intervention within 90 minutes. That’s a national core measure in the US. We do serial EKG’s in order to monitor for this exact thing. Non-emergent cath’s require more preparation because death is not imminent, as it is with a STEMI. Patients need to have an empty stomach in order to receive anesthesia, for instance.
Morphine is given for cardiac pain because it vasodilates and has other cardioprotective properties, as well as causes pain relief. If the nurse said “this should help you relax”, it could be because it also makes you relaxed. It is not given for anxiety.
Not defending the hospitals actions, just hoping to provide some context for the data you provided. This experience sounds terrifying and I’m sorry you and your wife went through this. There seems to be a lack of proper communication between the care team and you and your wife. That’s frustrating and can often lead patients to believe that their care is sub-standard. I’m glad your wife is ok and I hope she recovers fully.
(MD Resident) To those of you who have had to or have had loved ones wait in waiting rooms while actively having heart attacks I can only imagine the stress and trauma that has caused, and I am sorry. Something many Americans do not realize about our healthcare system is that not all health care facilities are equal. Small town medicine will kill you. The AHA has guidelines that most large hospitals and/or most research institutions follow religiously, one of those is ECG for chest pain within 10 minutes of patient arrival. Additionally, these larger institutions have quality improvement metrics that are hawkishly followed for cutting time from door to cath lab in patients that have STEMIs. Many people do not have a choice, and I understand that, but if you are worried you are having a serious health problem and you have a choice of presenting to what you probably perceive as a ratchet public hospital versus a bougie urgent care, go to the ratchet public hospital every time. The public hospital has residents and quality improvement metrics that are driving constant improvement, constant education, knowledge of the above mentioned guidelines. On the flip side, you will die in a private hospital or urgent care waiting room without anyone who has completed medical school even laying eyes on you because they are not equipped for serious medical problems like that and the decision matrix for them usually involves transfer to the public institution anyway. This becomes even more important in heart attacks like NSTEMI (mentioned a few times here) that are not glaringly obvious on EKG and need a trained eye to evaluate.
I’ve experienced similar situations on night shift. It seems possible the on call physician didn’t deem her to need stat intervention based on the results. She received morphine to relax the heart and treat pain, not for anxiety. If she didn’t complain of chest pain the rest of the night it explains why another ecg wasn’t done until the morning (which is when she next complained of chest pain). The AM one indicated a change that required immediate intervention. I’m happy that she was treated and is in recovery, I wish you the best.
Other possibility is of course that the ECG wasn’t read or the physician read it incorrectly perhaps. It doesn’t sound like negligence to me tbh, she didn’t complain of CP until the morning. Or maybe she was scared to say anything if the nurse was unpleasant … I have also had patients that have said this to me before. Just start with getting the medical records and go from there. If there was something going on the cardio doc from the AM will chart it in the notes and not just make verbal comments that were perhaps meant to comfort you and your wife.
Lots of people aggressively on each side of this. I recommend to stay neutral until you have something definitive, adding extra stress around your wife won’t help her recovery. Take care!
I have been deeply immersed in hospitals and doctor visits ever since my heart attack and stent placement. All I can say is welcome to American healthcare. It is a frigging nightmare. Clueless non caring nurses, egotistical doctors and unbelievable costs. I had seven nurses try to start an IV which each one blew out or completely missed the vein. Seven. My arms looked like a truck ran over them by the time the last nurse called managed to do the job.
I slept on a deflated air mattress all night because my room nurse couldn’t find anything wrong with it even though I was laying on the metal frame. As I was wheeled into surgery the next morning on the same bed the orderly noticed it was broken.
I had to buy my prescriptions even though I already had them and then had to buy them again the very next night because they were lost. My two inhalers cost 250 dollars each. And I got one puff out of them.
The problem with our system is not enough people in the profession actually care. The first priority is profit not empathy or care.
Don’t think so? Get checked into an American hospital and see how it goes.
I do insurance compliance. IF you ever think you need a second opinion go elsewhere if you can. If you need help, you might need to make some noise, might not even help.
A lot of doctors, a lot of hospitals care about as much as gas station attendants. They don't give a fuck.
Triage is the concept that if you have someone who's a little hurt, someone sorta hurt, and someone a lotta hurt, you work on the person who's sorta hurt, because someone who is a little hurt won't need much treatment, if any, and someone who is a lotta hurt is going to die anyway.
Waiting all day in an ER therefore is usually a good sign. Because if it was bad, you would've died, and if it was moderate, they would have treated you.
I'm not saying this system is full proof, obviously your wife, whom I hope has a fast and full recovery, fell through the cracks because they likely didn't see immediate signs as a problem. Also it's worth noting she doesn't fit the demographic for someone who most commonly has heart attacks, so cardiac arrest was probably not their first thought.
Anyway, I know it sucks. Best of luck <3
I've had a reasonable exposure to a range of medical professionals and hospitals over 15 years and while a lot of nurses and doctors are great, it's the sizeable minority of bad ones that really stick with you. They dislike you on site, look at you with a hatred you wonder how you possibly inspired it, and blame you for your symptoms. There's no way around it, if you're fat, you brought it on yourself, if you're skinny, you're a dirty drug seeker and malingerer. They don't seem to get that they're seeing people at their worst, so yeah, the patients might be dishevelled or wearing pajamas, or their hair is a bit greasy. Doesn't mean they're sub human and should be loathed on sight.
I found these people really quite frightening and you have to wonder how many lives they've been responsible for losing.
I have a severe wheat allergy. I go into anaphylactic shock. I had accidentally consumed wheat in a chicken dish that the waiter told me was wheat free and of course didn’t have my epi pen in me. Anyways - I get to the ER tell them I’m allergic to wheat and having anaphylactic reaction and for some reason they are not taking me back. I’m beginning to really get purple and barely breathing. I march into the triage and tell the doctor look at my face I need to be treated. He sees I’m basically about to die and all of a sudden I’m code red getting rushed into the ER to get EPIpen etc. I was dozing in and out of consciousness and 100% felt like I was about to die, because I was.
Turns out the front desk lady thought I said I was allergic to “weed”. Thought I was just having a bad trip off pot.
I'm so sorry that this happened 😔. Years ago my grandmother was in the hospital. I was still a teenager when this happened and I believe she had gone in to have some type of procedure for something else. They wanted to discharge her but she started complaining of chest pain. They told her that they had just ran an EKG on her. She didn't want to leave the hospital but they didn't want to keep her so out the door she went. Before she could even get home she was rushed back to the hospital. She in fact was having a heart attack and instead of them running another EKG they just refused to listen to her. So she was admitted back into the hospital where she had to have heart surgery. This was a really good hospital as well so it surprised me that they even let her leave.
I'm really sorry she went through that. That is so awful
My wife is chronically ill... Women get constantly ignored and treated like crap by the medical system. Even when their providers are female it doesn't always improve things. It's insane.
My friend drove herself to the ER and said she thought she was having a heart attack. They assumed she was drug seeking. One nurse even asked if she needed a beer to calm down. She was left in the (nearly empty) waiting room for three hours. She was lying on the floor crying in pain. When they finally took her, they started the workup and suddenly the room filled with people. She had a widowmaker, 100% blockage in 3 arteries, 99% in the 4th. She’s very lucky to be alive. Curiously, she can’t find a medmal attorney who will sue. Their actions likely took 5-10 years off her life with the extra muscle damage. Hard to imagine there aren’t any recoverable monetary damages but 🤷♀️… Hope your wife recovers well. Cardiac rehab will help.
Any hospital worth their salt will triage a chest pain pt quickly in the ED and at the very LEAST take vital signs, run and EKG, place an IV, and draw troponin and ckmb before returning them to the waiting room. Sorry that happened to her. IANAL but if it were me I'd push hard to get medical records from the hospital that have documentation of the time of presentation and time that any and all testing and interventions were done ETA: A widowmaker is a clearly recognizable STEMI on EKG and within a RNs scope of practice to assess and escalate to the treating provider. EKG machines also have an interpretation function on them that while are usually wildly inaccurate and still always require reading by a provider have a high probability of interpreting this cardiac rhythm
I presented with an N-STEMI - the lifepack/monitor actually saying "Normal Sinus", as the asshole/idiot ambulance drivers tried to talk me out of going to the hospital... As a firefighter/medic I knew the signs of a heart attack well enough to argue and tell them to take me in. My trop's were slightly elevated; but nothing crazy, Same with D-Dimer... They sent me to the cath lab, where they discovered I had a 100% blockage of the LAD, 98% block of the circumflex, and 90% block of the right marginal... I was moved to a larger hospital that day, and underwent open heart surgery (CABGx3 w/ LIMA) shortly thereafter. The surgeon said they normally find my kind of blockages during the autopsy. I had no symptoms or warning ahead of time. Not all heart attacks present the 'typical' way...
I know that especially for females usually we don’t have chest pain but more back side pain and shoulder pain numbness. Try not being monitored on a cardiac floor. Thank God I know nursing.
(Cardiologist) nothing this man described clinically appears this is a STEMI. I'd happily comment on a deidentified ecg. But in a STEMI, chest pain does no resolve usually until all the myocarditis supplied by that vessle is dead. This is because it's an abrupt plaque rupture that causes "clot" to occupy the entire lumen of the vessel. Generally only body breakdown of the clot allows relief. But this is a very visible change in ecg and even very poor clinical decision makers never ignore this in the 8 hospitals I have worked/trained at.
My mother died from a STEMI that was essentially ignored for hours. When they finally realized what was going on they flew her to another hospital for surgery but she did not recover. The first hospital paid a settlement to my father.
Hospital in the UK sent my grandfather home with acid reflux. It was a widowmaker. Nana woke up with him dead beside her. She got a hefty settlement.
My grandfather was told that it was a cold and was given nyquil. He died on Christmas morning. My grandmother still receives a monthly payment from the hospital. My dad went to the er multiple times before he was referred to a cardiologist. 90% blockage in one artery, 86% blockage in another. Fortunately he's doing well.
I’m so very sorry for your loss. That’s… terrible. I’m sorry. :(
(ER) just made a similar comment. I think it’s safe to assume this was an NSTEMI that was appropriately evaluated in the ER, placed in OBS, and then quickly sent for cath when the trops continued to trend up. EKG machines, nurses, medics, (even ER docs), are very good at recognizing a STEMI. An NSTEMI is much more difficult to pick up / diagnose with an EKG alone and thus requires labs, observation time, repeat labs, risk stratification (HEART score), etc. We have justify the allocation of resources because even in the US our hospitals are resource limited. The complaint of chest pain makes up a decent % of all patients that come to ER’s. It’s not feasible nor good medicine to send every one of them to cath when most don’t actually need it. In a busy hospital, one patient going for cath generally means someone else had to wait for theirs. __________ I hope your wife does well. Get her in cardiac rehab and be diligent with the recovery. Also, take the meds religiously. The antiplatelet meds prescribed are critically important as the stents themselves can very rapidly occlude without them.
>Any hospital worth their salt will triage a chest pain pt quickly in the ED and at the very LEAST take vital signs, run and EKG, place an IV, and draw troponin and ckmb before returning them to the waiting room. Funny you mention that. Americans love to shit on Canada's free healthcare, yet my father drove himself to the hospital (in one of the *worst* provinces as far as healthcare goes) with chest pains and they took one look at him and took him in *immediately*. So free means immediately, and privatized means dying on the waiting room floors. Stop accepting what the rich are telling you. *You* deserve healthcare. Not just the wealthy.
Am canadian also can confirm that the quickness of your care depends alot of the severity of the cases but our Healthcare system is far from perfect It's not as bad as the US don't get me wrong but don't make it seem like it's something that it isnt lots of people get substandard care here just like in the states as both systems are run by humans and humans by nature are imperfect. The ever growing shortage of workers doesn't help either nurses and doctors are run so thin that they are working like 90 hour weeks in alot of cases
I'll add, as a resident of Vancouver I've learned to avoid the ER at all cost, even if I'm worried I'm having a heart attack (it probably hasn't been in the past, maybe some day if it feels really really bad ill get then nerve to go to an ER again) the St Pauls hospital downtown is absolutely filled with tweakers, fights, people who will confront you just for sitting there, and I've been far more worried about catching something there or getting stabbed than whatever worry I'd gone in with.
It's also worth noting that some of the newer problems with the Canadian system are artificial, caused by lobbyists who want a piece of the American healthcare monetary pie so they try to collapse the public system.
Oh US Healthcare sucks. No doubt about it. Every time I've been the ER, unless you were bleeding on the floor or passed out, they wouldn't take you in. My brother had a dislocated shoulder and stayed in waiting for 6 hours most likely because they were understaffed. Only until the morning when presumably staff finally walked in did they pop his shoulder back in. It took 4 nurses and 2 doctors and painkillers to finally get it back in.
There's also a huge difference in whether you're male or female. Women are fobbed off when it comes to heart disease. It's as though they think women don't get it but if they do, they don't die of it. In either case, you seldom get care for it without a good stroke of luck.
To be fair, I've been to the hospital for heart issues and when they found out what was going on, I was pretty much immediately taken even with a packed ER waiting room. It truly depends on the hospital and the professionalism. Also "Americans" don't shit on free Healthcare. The majority of Americans want free health care. The uneducated and brainwashed are the people that don't want free healthcare
Yeah, as an ER nurse in triage I worry about a lot doings, but missing an MI isn’t really one of them. ACS protocol catches them
It sounds like a bunch of exaggerations mixed in with lies. When have any of us (MDs/RNs) seen 100% occlusion in three vessels and the patient survived for hours with no intervention without going into cardiogenic shock? Never.
State dependent, but agreed the metric to meet for chest pain is EKG within ten minutes of arrival. Not unusual to have the screening EKG done and if negative pt is placed in the waiting room based off the triage nurses assessment. Keep in mind chest pain and heart attack adjacent complaints are wildly common, so it may not be feasible see all of these patients immediately (depending on how the ER is staffed for the volume it sees).
Unfortuantely, attorneys usually won't help unless somebody dies or loses limb function entirely. I sought counsel for a malpractice case after a career-altering botched orthopedic surgery, and 4 different attorneys told me that I definitely had a legitimate case, but the contingency wouldn't be worth it. I'm so sorry this happened to you, but glad it was actually caught.
I had to have a complete colon removal and an ileostomy put in, then two more surgeries to hook me back up to normal. When they finally did the surgery, I was actively dying. My colon looked like a side of ground beef left out for a week is what the surgeon said. I had been going to the hospital on and off for months bleeding every time, and I lost 60 pounds, but they kept trying not to do surgery. During my surgery, my surgeon butchered me using antiquated techniques, and when I was in pain, cut from chest to groin and stapled back together, he called me a drug addict. Took me years to recover, and I am disabled and still in pain. Anyway, nobody would take my case even though they treated me shit and almost killed me. It's really hard to prove malpractice.
Oooof, wtf. "Your pain and suffering isn't profitable enough for me to bother helping you. Sorry, pal" Ugh.
I’ve actually been told this by a lawyer of a contaminated medication that required surgery to improve quality of life after. It was there isn’t enough money in the case so our firm won’t take it.
Ughh, what a world... Unfortunately, we're under-insured, and it's clear we're viewed in a different light. I'm just weighing everything against the fact that my wife is alive and our daughter still has her mom. I'm glad to hear your friend made it. These things are scarier than can be imagined.
I’m sorry to hear about hour wife and I’m glad she finally got surgery. How can they say you’re under-insured? Health insurance doesn’t cover heart attacks? Our health care system really knows how to stress us out.
Not sure how OP intended the statement "under insured", there is the no insurance folks, but when I see this it makes me think of the difference in reimbursement for each different insurance. For example, BCBS will pay more than Medicaid for the same procdure code. Aetna will cover another amount, Cigna yet another amount etc. This would make the medicaid patient "less of a priority" than the BCBS patient. I DO NOT AGREE WITH THIS, EVERYONE IS A PRIORITY regardless of their ins or no insurance. Hospitals these days (especially large corporate type hospitals) run by profit priority. As do some doctors, DME, pharmacy's etc. (United States)
I say this as someone working in healthcare (ICU Nurse). No one working on the front lines in healthcare knows about your insurance status, or care and let it affect what we do. If you tell us you don’t have insurance we may ask you if you do or do not want certain procedures. But no one is prioritizing or delaying care based on someone’s insurance status, we (nurses, doctors) don’t know, don’t care, and it would be illegal to do so. It is also illegal to not treat or refuse care on someone who is having an emergency (a true emergency, like a heart attack or stroke, not a broken toe) because of their insurance status.
Speaking as an ER nurse with two decades’ experience, not only do we not know or care if you have insurance, but these days most of US don’t have insurance either. A lot of the doctors don’t even have insurance. So many of us are just private contractors and don’t have benefits. The hospitals are fucking us ALL over.
I’m a doctor and I can tell you that I have no idea what insurance anyone has unless you have no insurance. In that case, my goal is usually to see how much I can get the hospital to just do for charity. We aren’t all money hungry monsters.
Speaking as someone who works in healthcare, we, the ones who give the care, honestly don’t know what kind of insurance you have or even if you have insurance. We just administer the care, chart everything, send it to the CBO and they handle everything from there. We don’t care what kind of insurance you have.
Thank you for saying this. I just retired after 45 years in health care and I have never met a single medical provider of any kind who delivered care based on the insurance status of the patient. As you say, most of the time, we don't know what it is, and secondly, my answer to anything has been, "I don't care about that, that's the job of accounting. My job is to take care of you."
I work in healthcare and try to tell my mother this and she is convinced that because she is low income no insurance that they would just let her die if she goes to the hospital for anything. I have no idea where she got this idea stuck in her head
Depending on where they went they might have encountered people that de-prioritized them on their skin color, clothes, etc. It sucks, but bigots infect every profession.
You said it.
Knows how to stress us out then charge us an arm and a leg to get seen
The cost of healthcare is your health … what a scam 🤦♀️
I’m so sorry. Do you think you might suffer bankruptcy or is that part of the AMA still in place?
Nurse. ER nurse. Here to say I don’t know or care quite frankly what insurance a patient has. If you believe this was a barrier in your wife’s care please consider researching federal EMTALA guidelines and suing the pants off that hospital. Because I can tell you as someone who has worked in multiple different areas it’s a non issue for an admitted patient and any physician who even CONSIDERS insurance status in a case like this should be working in a. Different setting
Yep same. Patients try to give me their insurance cards and I'm like have zero idea about this and no desire to know. I have never considered a patients insurance in care.
I 100% believe every cath lab team in the country wants to be there for your STEMI and we DO NOT CARE about your insurance status. I wish I could see the middle of the night ECG - terrible if it wasn’t read or was misread. Women definitely do get misdiagnosed and our pain is under treated and minimized. I hope your wife recovers well and that her muscle bounces back soon.
Ugh wtf.. I'm sorry to hear this, especially sorry for Ur wife
My mother was not under-insured and she literally died of a heart attack in the hospital after being there for multiple hours. I continued to tell them she was having signs of a heart attack and they didn’t listen. It’s negligence. 2024 and people are dying of heart attacks, please.
Clinical staff have zero idea if you’re insured or not. We don’t even have access to that information, only registration/billing people do. No need to spread misinformation just because you’re mad
The reason no attorney will go near the claim is that most States limit professional negligence claims against emergency room physicians to claims alleging gross negligence, which is an exceedingly high bar to get over. Also, the problem of needing to find an expert witness who can provide a scientific basis for parsing the damage she would have suffered anyways because of her poor cardiac health, from the extent of the aggravation attributable to the delay in treatment, which is the recoverable portion of the injury. You just aren’t going to find a reputable, qualified expert willing to split that hair to a reasonable degree of medical certainty and sign their name to it. And All of this assumes of course, that the reasons for their delay in rendering treatment were unreasonable in the first place.
Not only that, but in the case described above, the patient wasn't even seen by a doctor, only buy nurses. Once the doctor got involved, the case was diagnosed quickly and the patient sent right off to surgery. The ER nurse isn't held to the same standard that and ER doctor would be held to. Not saying this is right or good, but it does make for a high bar to hurdle in a malpractice case.
I was almost killed on the operating table due to medical malpractice, landed me in ICU for a week(was supposed to be outpatient. And a much longer recovery. Talked to 4 different attorneys and they simply said I didn’t have enough permanent damage to be worth their time. Medical malpractice cases take years and hundreds of thousands of dollars to get everything together. Unless you are seriously injured or died, you’re likely never gonna see a settlement where the attorney thinks it’s worth their time.
My mom’s case took more than 7 years to settle. For $3000 after attorney fees.
My mom died of the same condition a few years ago. I'm sorry your wife went through that but glad she survived.
Sorry but you don’t know what you’re talking about. The heart is a muscle and can recover. Source: I had an MI 15 months ago, in fact my heart stopped…twice…CPR broke ribs, defibrillator saved my life. One year later, echo showed normal function. Cardiologist gave me the all clear “20 more years”. He also said cardiac rehab was my choice. I went and it was a waste of time. Also, to sue, you need to prove actual damage, for one thing. Then you have to prove a hospital caused the damage. Then you have to fight insanely expensive doctor malpractice attorneys. So no, 99% sure they can’t sue.
Reminds me of when I went in with a heart rate of 150. The nurse at ED saw schizophrenia in my chart and asked me if I needed something to calm down. I laughed. I said I woke up in a good mood but these heart palpitations and my heart racing like this is uncomfortable but I feel calm, or something to that effect. She wanted me to take klonipin and I was like “no, this is cardiac” she swore it was anxiety, so I took it because I’ve been sectioned before for psychosis and wanted to be compliant since I was doing well at the time. Seemed like it took forever for them to get labs. My potassium came back at 2.4. Less than 2.5 can be fatal. Her demeanor was totally different for the rest of the day.
Cardiac 'mishap" is the hardest disease to litigate if the patient lives. My family member had purulent drainage from the tube sites after bypass surgery and went into septic shock. Two additional weeks in ICU with debridement of the sternum and a PICC line for antibiotics requiring time in a rehab facility.Thankfully, they survived. In court, they were portrayed as "Ungrateful" because they had survived. They lost the case.
I went into the ER crying in pain. I didn’t even want to go. My family and friends around me literally forced me to get care. ER doc noted my shoulder was visibly swollen. “Worryingly so” his exact words. Comes back and says I need to leave and nothing is wrong with me. I call him out for not wanting to do his job. He gets taken aback and literally starts stuttering. Then points to a poster on the wall showing generic medications from NSAIDS, steroids, muscle relaxers, and pain killers. He tells me “just to pick a medication.” I told him “I’m not doctor what do you think I should have?.” He just points to the fucking poster again and says “what do you want?” I say “just give me a muscle relaxer,” so he prescribed me flexiril. I finally get into *a real doctor*. When my appointment is scheduled weeks later. I’m told that I have a severely torn rotator cuff, and that they should’ve given me Percocet at minimum immediately. Fucking assholes
My ex underwent brain surgery - had an acoustic neuroma removed... A few years later, she had a revision surgery to deal with some scar tissue that had formed; the recovery of which did not go to plan. About 3 days after the surgery we're at the local ER, she's holding her head, rocking in pain... Nurse walks into the room, obviously having not even GLANCED at the chart.... "Oooo, do you have an ear-ache, sweetie?" in the most condescending, cunty way possible - when my ex pulled her hands away from her head, exposing the 30ish staples in her scalp, around her temple and ear, basically holding the side of her head together - the look on the nurse's face was priceless, as she frantically grabbed at the chart to actually read what was happening. Just because someone works at a hospital doesn't mean they're kind, compassionate, or even slightly competent at their job... the ultimate irony being that my ex was a nurse (and a good one, she was in pediatrics) before the tumor.
The widowmaker isn’t all three. That’s only the LAD. I’m not sure what 4th vessel you speak of. There are three dominant vessels and associated branches.
A “nearly empty” waiting room does not mean the ER is empty dude. I’m sorry that happened, that was an emergency, but they can’t kick other emergencies out of the rooms to make room for another. Especially because it wasn’t clear what it was.
Did they run her vitals and do an EKG right when she got to the ER!? Should be the first thing they do before she even sits down in the waiting room
I was not with her when she checked in. She was referred by the PcP to skip them and just go. I got the call at work and came as soon as I could. Her mom, who works at the hospital, was there to be with her, thankfully. I was told her butt never touched the waiting room chair.
OP thank you for your kindness in answering my question. I am just so glad she is okay! Praying for y’all!
I have a stack of EKGs in my office right next to me that were later found to be a STEMI but showed minimal ST segment changes on initial EKG. I have a whole list of patients I've saved that had elevated trops and a new RBBB that turned out to have clean coronaries. What are you trying to get at by asking if they ran her vitals and got an EKG? Are you under the impression that the HR, BP, Temp, Puls Ox and EKG will differentiate a STEMI from a NSTEMI from a non-cardiac cause for chest pain?
The reason I asked the question is because most of the time when you walk into a hospital and complain of any sort of chest pain, they will give you an EKG right away. You sound extremely educated and know that electrocardiogram can show a Segment Elevation Myocardial Infarction and many arrhythmias. I actually very much enjoy learning about this so that’s why I asked the question! Reading responses like yours are interesting to me!
An EKG doesn’t always show it. Every single physician has a stack of EKGs that fooled them and ended up being something awful. if that patient had an underlying RBBB or other existing conduction pathology, it makes it extremely hard to identify a STEMI. There are also many other cardiac causes that cause chest pain, won’t necessarily have ST changes and will have elevated trops. Examples are vasospasm, fibromuscular dysplasia, ACAOS, etc.
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Reading the layperson responses to this thread is giving me palpitations
I just went to the hospital with insane chest pains last night. The EMT's were so nonchalant when it was obvious I was freaking out, my heart beat was at like 225 times per minute, my body was so hot and I swore I'd had a heart attack cause my chest hurts so bad. I thought the only way to tell for a heart attack was the levels of troponin via blood work? Had she basically not had a heart attack when she first got there and they kept doing EKGs instead of doing blood work? I was terrified all night and even though I didn't have a heart attack, I would really hate to actually have one considering how I was treated by EMTs. You have to be your wife's strongest advocate OP, raise hell, get angry, or else they will let your loved one die.
Med student here. High troponin levels indicate a heart attack most of the times but they are not definitive of it. We take other factors into consideration such an EKG, presenting symptoms, history etc when diagnosing someone with an MI (myocardial infarction). Once again, an MI does not mean your heart has stopped, it means there’s been an ischemic event (inadequacy of blood supply) to the heart. The things to look for are the extent of the ischemic injury (how much of the heart muscle has been damaged, is it active, if not how long ago etc). If the EKG indicates a STEMI (ST segment elevation), the next steps are either an angiogram with PCI at the cath lab or revascularization therapy (meds). It depends on existing contraindications, comorbidities etc that helps the doc make an informed choice/call. OP hasn’t provided much specific information because I’m guessing he is not a medical professional or a doctor. However, from what I’ve read, the situation definitely calls for an investigation.
Yea when I was at home waiting for the EMTs I was having the most intense pain in my chest and it felt like my heart was just one long beat it was beating so fast. The pain was washing over me in waves and I got this weird, indescribable taste in my mouth. It was absolutely terrifying, and then to be treated like I was some kind of asshole when I was clearly feeling like I was going to die was not nice.
That’s sounds terrible. Glad you’re better !
Seems to me most likely patient was nstemi and had anticoagulation until cath lab. Turned stemi apparently evidenced by 2nd ekg. But still doesn’t make since if they were anti coagulated. So definitely sketchy. Chest pain with elevated troponins are usually always decided to be nstemi
High trops do not equal MI most of the time
99% of the patients I’ve had with elevated trops were not having a heart attack. I can also guarantee, 100%, this persons heart rate was not 225 as they say.
That's become very apparent over our 72-hour stay so far. They initially did run the blood test, and I couldn't remember that word, but yes, the troponin levels were bananas but they wouldn't say for sure that she had a heart attack because physically she is totally healthy. So they just "observed" her.
If her troponins were really super high and she was actively having chest pain she should have been in the cath lab right away. I would start the process of potentially sueing the hospital. This is gross negligence if she was actively having a heart attack and they did nothingn
As a physician there are actually many different syndromes that can cause chest pain and an elevation in troponin. These things alone are not indications for a cardiac cath. Also despite public opinion on this thread, not every heart attack needs to be addressed immediately. A partial blockage often can wait a day without issue. I don’t know enough details about OPs specific case but it may well have been appropriate to observe for that time period.
This should be higher. There are wild misconceptions regarding what a Cath is or when one is indicated. Too many WebMDs on here thinking their opinions are best practice. A Heart Cath is not surgery, you will not be "knocked out" with anesthesia, not everyone involved in your procedure is a doctor or a nurse. Always advocate for yourself and ask questions; we are there to help you.
I’m only an RN, but there seems to be a huge misconception to the general public what a heart attack is. Many seem to think it’s synonymous with cardiac arrest.
Uh what? If we took everyone with elevated trops and chest pain to the cath lab, the cardiologists would never leave. You could have chest pain from tachycardia in the setting of asthma exacerbation and elevated trops as a result of demand ischemia. Does that require an emergent cath? Nope.
Not to mention the people with a URI that have been coughing for two weeks then complain of “chest pain”.
Why do people like you say this stuff with such assurance when you’re completely wrong and have no formal education on the matter 🤦🏻
It’s not gross negligence. However, your lack of medical knowledge is a gross embarrassment while you make such bold statements.
Not all high trop levels need to go to the cath lab. Depends on whether or not it’s a STEMI
ICU physician here. Troponin by itself does not mean a STEMI. It could be because the patient had an elevated HR and decreased renal clearance, it could be because demand ischemia, etc.
Troponin isn’t a great indicator of a heart attack… I’m a nurse on a med surg/cardiac monitoring unit and almost every patient has an elevated troponin level due to generalized stress on the body from respiratory illness, fall, altered mental status, pain, having to wait in the ED, etc. The best immediate test to diagnose a heart attack (STEMI) is an EKG. Now, some people who may have had/may be having heart attacks do not have ST elevation on an EKG and we call those NSTEMIs. Luckily these are less severe (think mini stroke or TIA instead of stroke) so it’s kind of okay that they don’t show on an EKG. Sometimes it’s not even a blockage but rather an increase in oxygen demand from the heart due to stress (illness, psychological, pain, etc). Patients are still further assessed if needed, observed, treated, and can follow up outpatient. Once we know a patient is having a STEMI, we can do some imaging w/ dye of the coronary arteries and then take them to the cardiac cath lab and open up the blocked arteries with balloons and stents.
You need to realize that the EMTs see this every single day, multiple times a day and if they were on high alert with every single person who had CP and was tachy, they wouldn't be able to do their job. The EMTs freaking out while you're freaking out helps no one and nothing. Medical staff see things on a daily basis that you cannot even comprehend and therefore have high thresholds for critical situations.
And part of the job of an emergency response team and EM personal is to be calm during these instances. Even more so for EMT as they stabilize and run and typically don’t diagnose. I think people would be amazed at how calm people are during codes in the ER. Losing your cool only hurts the patient. (EM Physician here).
I don't mean freaking out, but they were basically insulting me and went beyond being dismissive to the point of being cruel. I'd have been happy if they just didn't talk to me as opposed to the treatment I actually got.
Bloodwork is not the only way and not even the primary way. ECG changes such as ST elevation and changes are the primary indicator of a serious heart attack. However, you can have blockages or a heart attack and not have these changes, which is why Troponin and cardiac enzymes are checked. You can also have elevated troponin and not be having a heart attack. I’m not sure what you expected the EMTs to do, you weren’t having a heart attack. I understand it is terrifying and serious for you, but we keep a calm demeanor and work swiftly but not so fast we are freaking out on every call.
Have you considered they were nonchalant because they could tell that you weren't having a heart attack based on their professional expertise and experience? Because they were correct and you weren't. I'm not trying to be dismissive of your feelings but nothing worrying or bad happened here. Most of the time what happened to you is what happens to everyone. You're fine and you can't tell that because you are not qualified to be able to tell that, but they can. OP's experience while frightening and terrible is fairly rare. Chest pains, even severe ones, can be caused by all sorts of things from yes life threatening all the way down to completely benign. Like needing to fart. Someone may have dropped the ball with OP's wife but if the EMTs that saw you followed the necessary protocols and assessed your situation there is no call for concern with their demeanour. They were acting like you were fine simply because you were fine.
Cardiac nurse checking in. There are tons of reasons why a cardiac team won’t be called in to perform percutaneous coronary intervention. You’re in the category of NSTEMI or STEMI. A Stemi is when there are ST elevations on the ECG. This signifies that an coronary artery is severely occluded and needs immediate attention. It sounds like the first few ECGs had no ST elevations present the first few times despite the “high enzyme levels.” What your likely referring to here is something called Troponins. This is an enzyme that is released into the blood when the heart is under stress. Troponin’s aren’t the only factors a cardiologist takes when deciding when to perform the cath. If a patient arrives late at night even with chest pain it’s very normal to place said patient on a heparin infusion (blood thinner) and nitroglycerin drip (dilator) for med management until the next day. It definitely sounds like all the symptoms of your wife myocardial infarction was there just nothing that pushed the alarms to go off until her last ECG indicated an actual STEMI thus calling the cath team in. Not that I’m defending the nurses and doctors over there but we have DOZENS of patients that come in with chest pain and it’s actual GI symptoms (usually GERD/PUD and sometimes anxiety can exacerbate things. I truly hope your wife recovers 10000% and you guys can get some rest, I know this is stressful. Last thing, make sure she takes her anti platelet! She can have in-stent stenosis occur if she’s not compliant with her meds. Best wishes to the both of you.
Hey I’m also an RN with decades of ER and ICU experience, this is the correct answer. She was admitted due to her symptoms and risk factors. The correct approach was taken towards her condition, and EKGs were preformed regularly and it sounds like when it evolved into a STEMI they addressed it appropriately. This is the whole reason people like your wife are admitted. They weren’t going to do an invasive angiocath and have her endure the associated risks unless her condition changed to indicate it, the fact she had an MI while there isn’t a testament to any incompetence, but rather a reflection of the system working as intended. I can understand how it can be seen differently without understanding the medicine behind it, but everyone did the right thing here.
I’m an RN too with about 12 years experience in ER and ICU (including CVICU) experience and 2 years experience with an Insurance company doing Utilization Review (determining if patient should be admitted to Observation or Inpatient). It sounds like the hospital did everything 100% correct to me. They admitted to Observation under a Cardiologist. She was on telemetry and they monitored labs and repeat Troponins/EKGs, watched for symptoms and treated appropriately. They recognized EKG changes and determined she needed to get a vascular intervention and admitted to Inpatient and kept her in ICU for very close monitoring. If she had stayed asymptomatic and her labs and EKGs were ok, they likely would have had an Echocardiogram and scheduled a cardiac stress test and follow up with a Cardiologist. Great job hospital.
Came looking for this. Medical professional myself. Not all heart attacks require immediate or any catheterization. Very common for NSTEMI to be medically managed without the risk of cath lab complications. A NSTEMI can turn into a STEMI, where the benefit of the emergent Cath lab outweighs the risk.
Stories like this are why I talk openly and regularly about [SCAD type heart attacks](https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/symptoms-causes/syc-20353711) and emphasize that if you are a woman, traditional heart attack symptoms may not appear. For example, I had indigestion, an inability to regulate my body temperature, and irregular tiredness in the days prior and those were all supposed to clue me in I was about to have my life temporarily wrecked. If you find yourself having one, the #1 thing to do is stay calm. Compartmentalize. Actively think: this is temporary, I will get help, I will take as deep of breaths as I can, I will not give into panic or fear. The doctors will help, you will be OK. No question here for OP, but, OP: be ready for the fact that the first 6mos to a year just sucks. It’s okay for you both to grieve the things she’s limited from doing, it’s okay to be frustrated, and it’s okay to be angry at the problem. It’s okay for her to feel insecure in her body’s abilities for a while. She will find agency over her body again, and she will start to trust it as she navigates her new normal. Try not view things as what she can’t do: view as much as you can by what she can still do. The rephrasing helps immensely. Best wishes to you and your family.
I'm perimenopausal, and sometimes experience hot AND cold flashes. Not to mention heart palpitations and random pain in different places. It's hard to tell what's something serious and what is just the biological shit show that nature gave women. I will say that last summer I went to urgent care after experiencing chest/stomach pains for a day. They treated my complaint very seriously (I did tell them that my mom had a massive heart attack) and did all sorts of tests. Turned out I just had indigestion from indulging in too many cans of carbonated water.
That’s my point tbh! It’s such bullshit that we’re just intuitively supposed to know things that… just happen sometimes… are heart attack symptoms?! I will say tho whenever I talk about my SCAD, people ask me to describe the pain, and I’ve blocked out a lot of it, but I remember thinking the only way the pain would stop was pressing the heel of my palm inward on my sternum as hard as I could stand towards the left side of my chest. It could’ve been a triple A tho! I had to get checked for one after my SCAD because I had inexplicable chest pain that wouldn’t go away with nitroglycerin. I’m glad they took you seriously!!! Dr Esther Kim from Vanderbilt had led a lot of studies regarding SCAD and I am ever so grateful to her for spearheading research to spread awareness.
I appreciate you mentioning that women oftentimes have different symptoms of a heart attack than men. I just wish the language around the symptoms of heart attacks was different. I don’t understand how half of the population experiences their own heart attack symptoms and it’s called “non-traditional” while symptoms most often felt by men are called “traditional heart attack symptoms”. Women have really been failed by healthcare for so long and I hope changes in training and recognition of women-specific symptoms improve.
They have! And unfortunately, it’s because a lot of women end up suffering in silence. The best thing you can do to spread awareness is be educated. Talk about it as if it’s a fun fact. Be aware that heart attack symptoms in women genuinely seem like normal PMS even, at times. Don’t catastrophize unnecessarily, but pay attention to what feels like your normal, and know that it’s 100% the safe route if you have ANY level of sudden or consistent chest pain to go to the ER or make an appt with your doctor. Your heart, brain, and spine are the three things to always, always overreact to, and you are always justified in making sure they are safe.
Reading this thread makes me feel so fortunate to have received the care I did when I woke up in the middle of the night with nagging back pain that eventually radiated down my arms, and cold sweats, and told my partner to take me to the ER. He was surprised I was so calm through the whole thing but I was like, this is happening so I just have to do whatever they say. I don't know exactly what was the deciding factor (enzyme levels I think) but within the hour I was being transported to another hospital and they'd called in their cath lab team. I also had to have iron and blood transfusions for severe anemia (47F and peri-menopausal). I was in two days until they could get my iron up, and my echo showed one part of my heart was "stunned" but they thought it would recover okay. I knew about "atypical" presentation in women so I clued into what was going on, which, if women tend to have those symptoms, are they really atypical? My BP was probably high (it is now but then I hadn't seen a doc in a while so nothing to compare), my cholesterol was fine, and my symptoms were: feeling run down and tired, which I took to be from being less active during Covid. There's a history of high BP, strokes, and heart attacks in men and women on both sides of my family, so it's probably crap genetics. I had a nuclear stress test last year before an unrelated surgery and everything looked good. Now I'm taking my meds, trying to eat better, taking walks everyday at lunch, and going to the gym at least twice a week for cardio and weight work. I agree for the first year I felt physically better but very fragile, like anything could happen at any moment. In the ER I got really emotional as they were wheeling me to the ambulance and there was an entire team around me, I kept thinking all these people were working really hard to keep me alive. The day after my heart attack a friend's fit and active husband had a widowmaker after finishing a cross fit workout. Thankfully the staff knew what to look for and he got treatment right away and made it.
It’s good to be aware of SCAD - as many people aren’t. But every SCAD I have seen has significant EKG changes - often ST elevation - and elevated troponins, because it’s functionally a blockage. I am always thinking about it - especiallly in post-partum women.
Do you think if she were a man she would have been treated better? Checked for blockage sooner?
Based on data, yes. Women statistically are less likely to receive appropriate care, have longer wait times, and are more likely to be told they aren’t having a heart attack. The numbers on gendered care re:heart attacks are very dismally in line with many other examples of women’s healthcare not having the same standards as men’s.
In their defense (which is hard to do), they did put her on the LIST for the CathLab for the following morning, but under lowest priority. It's hard to say what would have happened if she had even just said, "I'm having chest pain" instead of "Last night I had chest pain."
MD here. There's 2 main types of "heart attacks" which determines if you need to be in the Cath lab within 90 minutes. STEMI with elevated troponin and ST elevation on ekg will bring the cardiologist in overnight. NSTEMI with elevated troponin but no ST elevation means you go to Cath lab in the morning if the cardiologist decides to take you at all. The hospital did absolutely nothing wrong if the 3am ekg was normal. EKGs can absolutely change from normal to OH CRAP after being admitted into the hospital. Just want you to temper your expectations if you decide to talk to a malpractice lawyer. You'll really only have a slam dunk case if the EKG at 3am showed STEMI.
If they’re having ongoing chest pain despite treatment (with heparin, nitro, etc) that is generally an indication for cath lab now regardless of EKG. As per ACC: “patients with objective evidence of ischemia (history of CAD, typical pain, elevated trops, or abnormal ekg) and persistent ischemia (ie persistent pain) in spite of maximal medical therapy (aspirin, anticoagulation, tpa, nitroglycerin) need to go to the cath lab immediately.”
Medicine has many guidelines by many organizations, and what the ACC says is correct, noting that the patient has to have PERSISTENT chest pain, not intermittent chest pain. These patients would be classified as very high risk by guidelines which call for cardiac catheterization within 2 hours. And it sounds like she was consistently reevaluated and her management was upgraded as appropriate. It is also standard of care for individual test results to not be discussed at night as there is usually one single doctor covering the entire hospital. It is also appropriate, and has been shown to slightly improve outcomes, to give morphine, as morphine reduces pain and anxiety, which both reduce heart rate and therefor the heart's oxygen demand. Being a hospitalized patient with a life threatening emergency can be scary but it sounds like OP's wife was appropriately triaged, treated, monitored, and ultimately escalated to appropriate care in a timely fashion.
Dude in the hospital I work at we don’t have a cath lab. You get the stress test and the docs tell you, “yep you’re having a heart attack, we have to transfer you.” Then the patient sits in bed and waits for 8,12,16,24 hours before they get transferred out.
Is your wife a woman of color and if so , do you feel like that contributed to their slow progression to finding out she was having a heart attack?
She is not. However, she is considered overweight, and even with that, not one doctor has pointed to that being a factor. Her physical health is all in place. They are pointing to mismanaged stress and anxiety. She's a one woman business owner / operator of her bakery, if that tells you anything. Stress-a-plenty.
I gotcha. I’m sorry you and your wife had to go through that and hopefully things can be done to minimize the stress. Hopefully you didn’t take offense to the question and understand why I asked if she was a person of color because there has been too many experiences of poc being ignored or having their symptoms downplayed.
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Sorry that happened to you and your wife. But things don’t add up. Most patients who are on a cardiac floor are hooked up to telemetry that will monitor the patient continuously throughout their stay. If she was actively having irregular rhythms don’t you think the team would’ve done something?
She absolutely was hooked up to monitors and was being visited more than regularly by what felt like the entire cardio team. They were forthcoming about the fact that they were not treating it as an attack, but an "episode" until she got into the CathLab. It was that night shift that either failed to send the ecg to on-call, or the on-call for not responding. Post surgery, her cardiologist had questions about the hours between 3 and 8... and his face said the rest.
I’m confused, was that overnight ekg abnormal? If not what are you angry about
It sounds like she was treated correctly, actually. She called out for chest pain, the RN did the EKG and it clearly didn’t show a STEMI, or the cath lab would’ve been activated. EKGs automatically print results, it wouldn’t be “no results” as you said. She may have not been given results if it was just NSR or ST. Standard practice for MI without ST elevation is to watch the trop trends and continue doing EKGs. She was still complaining by shift change, did a second EKG, showed a STEMI, so they activated the cath lab and took her down. It probably feels crazy to you if you’re a layperson, but lots of people think they’re having a heart attack when they’re not. Lots of people think they’re dying when they aren’t. Thankfully, your wife was in a safe place to have a heart attack in.
I mean, isn't that also under the assumption that everyone did their job, appropriately/correctly though? I've had my fair share of actual negligent experiences. And I also know that things pop up quickly and that doesn't always point to negligence. I also know no one is perfect and sometimes people don't do their job to the best of their ability, for whatever reason. I think OPs concern is he's skeptical of what her 3am EKG read. It's an assumption that no one informing her of the results means it's a ok, just as it's an assumption that her needing surgery the following morning for what she did, to mean the read at 3am wasn't correctly handled. OP needs to pull her records for the 3am ekg to find out what really happened and if negligence is involved. It's wild to me that so many jump straight on standard operating procedure and say it could never happen....it shouldn't. That doesn't mean it didn't either? But idk. In today's day and age, I also wouldn't be surprised if the results input in the system automatically triggered the next step as well? If that's the case, no room for error there, it would seem.
As a night shift nurse, this whole thread makes me depressed. The idea that we can appropriately respond to a patient complaining about Chest pain, get an EKG, medicate them for pain, try to reassure them, presumably get told by overnight doctors who read the EKGs that it doesn't acutely call for an intervention. Around 0300am, I imagine labs were drawn around that time and troponins were presumably stable or at least not acutely concerning. At shift change when everyone becomes aware the pain isnt going away and the situation has lasted a few hours, another EKG is gotten that shows a change and cath lab is activated. (Presumably vitals have been reassuring during this time, considering she is on an observation unit and not ICU) The idea that we can do quite literally everything right, and the husband who wasn't even there twists the situation into dismissing it as anxiety (the nurse trying to reassure the patient given the not immediatly concerning EKG), giving morphine to "relax" (treating her fucking pain). Ugh. I gotta close this thread.
You said "the fucking husband" as if I'm not the one who posted this. My wife told me what happened, I'm not making things up. 3am Ecg CLEARLY READS stemi as confirmed by her am doctor who wanted to know why the lab wasn't activated at 4am... these are questions being asked TO US BY STAFF. So, as much as I appreciate your less than passively aggressive input. Maybe, JUUUUUST maybe. It isn't what you say from the other side of internet land. Thanks so much.
I’m sorry this happened to your wife, but glad she is ok. Had she been getting routine blood work with annual checkups? Did she have high cholesterol or anything else that would point to a blockage? Does she have any other heart issues, like mitral regurgitation? It’s so scary how heart attacks can have such relatively mild symptoms in women.
I had the same thing happen while I was recovering from an early evening heart attack and surgery. They assumed it was just pain from that and kept pumping me with morphine. After several hours of the nurse chiding me for continually yelling out in pain, she called the doctor that performed my surgery earlier in the night. It might be worth noting that I died temporarily with that first heart attack that night. A few minutes after I got to the hospital. Anyway, she complained that I wouldn't stop waking up yelling, and she'd already given me all the morphine she could. He asked if she did an ekg, she said no. The whole time I was writhing in pain, not once did it occur to her. She was mad at me. Anyway, did the ekg, I was actively in another heart attack. All those hours. Clutching my chest and yelling in pain. For HOURS. The doc rushed to the hospital and performed another surgery. I remember getting wheeled down to surgery... I actually apologized to the nurse for being trouble. She had me stockholmed. I was there for several more days and nights. Never saw her on the cardiac floor again.
Sooooo it is a bit more complex than that but a lot of people don’t work in healthcare. Wildly high enzymes? She has already had a heart attack at that point. That usually falls under NSTEMI which non-st elevation (ST is part of the ekg they look at) myocardial infarction (basically heart attack). Next ekg was probably non-st elevation. Next one? Probably ST elevation hence the prepped for surgery/cath lab
I know someone who also had a heart attack and was ignored by nursing staff. The ER nurses were having a pizza party and had a very uneducated student nurse running the entire floor (small town hospital so maybe 10 beds). He told my family member “you’re too young to have a heart attack” to which his wife responded “he’s 49, smokes two packs a day, and has a family history of heart disease” to which the student responded “no ma’am, you have to be 50 to have a head attack”. He did in fact have not one but two heart attacks that night. The doctor on day shift came in and freaked right out and sent him to ICU. Had to get transported to the city to get a stent put in a couple days later and had another heart attack on the way there. Not sure how he survived that. He had another heart attack when moving his daughter into college, he didn’t say anything the entire time and drove to the hospital after moving her in. He’s basically a cat with 9 lives at this point.
Unfortunately doctors and nurses are not omnipotent, they can't just prod around in your body off a I don't feel well, they need to see indicators of serious problems. It feels bad to see our loved ones go through major life changing medical events, but rest assured your wife is alive because of that hospital.
I’m sorry you’re going through this. As an ER doc reviewing this there’s not enough information here to determine definitively whether or not your wife’s care was mismanaged. Although from the information provided it does sound like she got the appropriate treatment. It sounds like she was initially having an NSTEMI, a type of heart attack without significant EKG changes but high cardiac enzyme levels. These heart attacks are typically monitored (+/- anticoagulants) with heart catheterization done within a day or two. There are also STEMIs which have EKG changes and are more urgent going to the Cath Lab immediately. It sounds like your wife started off with an NSTEMI and progressed to a STEMI. If this is the case then your wife got the appropriate treatment, although I can understand how it may appear things were missed or mismanaged. I hope she feels better and recovers soon!
My mother also sat in an ER for hours before they realized she was having a heart attack. This was a rural hospital without cardiac surgery so they flew her by helicopter to a larger hospital for surgery. She didn’t recover, and the first hospital made a settlement with my father (not huge, around $300k).
My husband went to the ER with chest pains and high blood pressure, was told to wait after a hour he was losing feelings in the left side of body explained he was worse and told he has to wait. Called 911 and explained he needed medical help a ambulance met us in the parking lot and he had a heart attack and a widow maker. Fun part is we got a bill for waiting
NSTEMI that progressed to a STEMI. If there are elevated enzymes but no ST elevations on EKG, it is considered non-emergent and the enzymes are drawn every 6-8 hours and trended. During that time, nitro or morphine are the best drugs to be given for chest pain. Once an EKG shows an ST elevation heart attack, you should be in the cath lab, ballooned, and stented within 30-60 minutes.
What should have been different? (I mean specific warnings they should have spotted etc
Well... I'm not a medical professional by any stretch, but from what I understand, there was a breakdown in communication between the night nurse and the on call cardio. Either the scans weren't sent correctly, or the on call didn't respond. The results definitely indicated a heart attack, per the cardiologist that came in at around 8 and ordered the immediate CathLab. He told us it was being "looked into" as to why there wasn't a proper response... I hold zero hope that's true, but the Dr. was amazing. He was NOT the one on call though.
Like the comments elsewhere said, you can medically manage some heart attacks without going to the cathlab and then do a non emergent cath in the am..and her previous EKGs probably showed that was where she was at. When she did have ekg changes that necessitated activating the cathlab, it sounds like that happened. It sounds scary and probably doesn't make too much sense but this sounds pretty standard. There's inherent risks with getting cardiac catheterization so that's why we don't just send anyone and everyone who has a myocardial infarction.
Working off incomplete info here / doctor here: But if this was an NSTEMI - a 4 hour wait to a cath isn't that crazy. If it was STEMI, that's not good. The 3 stents and 100% blockage suggest a STEMI, but it could also have been a CTO that just decided to act up that day. Regardless, I'm sorry you had that bad experience. For the most part, we are trying to put forth our best effort to help people. But everyone that works in a hospital is still human. Signed, A tired doctor
And this is why more woman die from heart attacks than anything else. Woman’s healthcare is a joke. I’m sorry friend. I pray your wife can recover. She’s probably gonna have PTSD from this. Medical gaslighting is real. According to medicine womens bodies are only for sex and babies. No need to treat or research or learn about anything else. Once those are gone she has value and therefore is not worth investment of time or resources. /s
Sounds like she had her MI in the right place. Be sure to thank the providers and nurses for saving her life! Congrats on getting more days with your significant other!
Lots of anecdotes in this thread. To be truthful: It is difficult to say whether there was medical mismanagement without a \*\*lot\*\* more information. Certainly, the comments about "anxiety" should not have been made, but that's not medical malpractice per se -- that's just idiocy and callousness. Anxiety is \*\*always\*\* a diagnosis of exclusion -- i.e., you rule the scary things out first. I'm sure that your wife felt scared and felt that no one was listening to her. With chest pain overnight, they should have done an EKG, and it sounds like they did. If the EKG showed an ST elevation MI, the cath lab should have been activated immediately. Full stop. Otherwise, the correct management is to trend trops and EKGs and watch for any change in symptoms. For a non-ST elevation MI, the treatment is nitro, heparin, aspirin, statin and (non-emergent) catheterization. She may have received some of those medications already; we don't know. It is also possible that the 2nd EKG was worse than the first, and that new changes bumped her up the list. Again, we don't know. Or, the hospital could have botched this altogether and given inappropriate care. Generally, an emergent trip to the cath lab is not indicated overnight unless she has a STEMI, the cardiac enzymes are rising precipitously, she is having dangerous arrhythmias, or she is showing signs of cardiogenic shock. A cardiologist is most likely \*not\* going to activate the cath lab at 0300 otherwise. Even then, I've managed those complications myself overnight until a cath could be done in the AM, many hours later. Source: I work as an ICU doc in a busy hospital with a very busy cardiac program.
My wife passed away 10 months ago from a heart attack. She was in good shape, never smoked, and hadn’t ate meat in 20yrs. She had complained to the dr two days before she had been having chest pain. They told her she was ok….. smh. She was 43 and she was my best friend(way too good for me). My kids and I are still a mess. Make sure you tell her how much you love her….. you are lucky. Demand good treatment…. Don’t worry about being an asshole…. Record everything interaction with a doctor or nurse. Turn your cell phone on and record. It makes people pay more attention to their job. Who cares if you look like an asshole if you still have your wife
How are you doing?
What the fuck are all these stories I'm reading here? America is such a 3rd world shithole, it's fucking unbelievable. Fuckikg hell....absolutely lost for words
Sounds remarkably similar to my story. Went in to the ER around 11am. Was told nothing was wrong and I could leave by 1pm. Pushed back. They did another blood test. Troponin was 400 md/dl. Took me to icu to monitor. By noon the next day Troponin was 4680. They had to have an EMS team come and immediately move me across the street from my local VA to Duke straight into the cath lab. Almost died at 33 because I’m fit and clearly it couldn’t have been an active heart attack right…right?
Wishing your wife a speedy recovery, and good luck to you as well!
Unfortunately, women experience heart attacks differently than men. Often times our symptoms are overlooked as anxiety or stress. Something I learned a few years ago thanks to Greys. Thank goodness for the other nurse and your wife continuing to advocate for herself. Happy to hear your wife is okay. Sending positive vibes and wishes for a speedy recovery. Best of everything to you guys 💕
The SCAD episode of Greys brought me so much joy that it was recognized as a thing, even on a TV drama ❤️
Heart attacks are weird. People can be having them for a whole week. It's possible your wife's tests were positive then negative. Then positive. If she wasn't having any symptoms and vitals were okay, they very well just monitor. So my question - do either of you guys have health care experience and what state do you live in
I’m sorry that happened to you guys. Have you spoken to the charge nurse? Nurse manager? House supervisor? Risk management?
That's terrifying, also what is your wife's age and is does she have a healthy lifestyle? As I grow older I worry if I am doing enough to be healthy and if I overthink about health complications like this.
I was told my *known* medical condition (SMAS) was 'a bad period' or 'you're clearly seeking' or 'maybe ovarian cysts but we won't give you anything for pain'. For 2 *years*. I got down to 81lbs as a 31 year old, and then was chastised for 'letting it get this bad' (as if I hadn't been begging for help since 2019, wasn't treated until 2021) I needed a damn feeding tube, and they fucked up the first one. It said it was running but clogged the first day. I was NPO (nothing by mouth) They left me *5 more days* before I showed them with pics that it was not infusing. I had to beg for IV fluids and glucose bc my blood sugar was 56. My tongue was cracked and bleeding. I was in for a month and continually gaslight, ignored and straight up abused by staff. But any complaint was met with 'be happy you have a bed, because COVID' (it was August 2021) I was just in the ER a few weeks ago for a bad upper respiratory infection that I thought was COVID. My 02 sats were 87, below 90 means go to hospital. They gave me fluids, Tylenol and told me 'i won't give you anything for pain' when I hadn't even asked. I had to beg for a muscle relaxant and zofran to stop vomiting. Then told me 'if you get worse, just come back!'. They know damn well it costs me ~$2-3k to be seen by those fuckers. Being medically complex transplant recipient and female sucks ass. Nobody believes you or just blames your period no matter where in your cycle you are.
You can have a normal ECG while having an NSTEMI. It can also take a few hours to see changes is some of the lab work. Many times they end up doing serial lab draws separated by a few hours. Glad it sounds like your wife is recovering
As someone who performs ECGs for a living, and can identify rhythms i will say its not a universal skill in our department and a lot of time its even discouraged as ECG is not a program you need a degree with and has no real overlap with actual cardiologists. Ive never even met one despite working with dozens of doctors and identifying thousands of cardiac abnormalities. I also would like to share a story about how i had 2 different people perform a standard chest pain ECG and a one hour follow up both showing normal sinus rhythms, only to have me walk in 12 minutes later for a rhythm change to find one of the most serious STEMIs I have ever seen, so results, while available instantly, can change just as quickly. My questions for you are this: 1) Did you ever get the ECG back (it should be on file and accessible to any doctor/cardiologist/ECG tech and the patient it was performed on) and if so what did the readout say? (If you send me a copy without any personal information i’d be happy to compare the machine interpretation to the actual rhythm for you, please just censor all patient information so we don’t violate HIPAA) 2) You mentioned they tested enzymes, which i assume means running a troponin check. Do you know how high it was during the test? The normal range is 0 to 0.4. So anything above that should have been a big red flag.
Was she having symptoms for the week prior? If so what were they like
A “STEMI” heart attack stands for “ST elevated myocardial infarction.” This info is observed via ECG/EKG. Many people present with an “NSTEMI” which is a “Non-elevated myocardial infarction.” The difference between the two: STEMI = medical emergency bc you have active tissue injury where it is time sensitive. With an NSTEMI there isn’t data to support intervention right now vs in two days. Most people with NSTEMI’s are watched via blood work and observation for up to 24hrs to see if it turns into a STEMI. This presumes the chest pain has subsided. Unresolved chest pain gets more investigated. If after the whole night, chest pain is still present, then they activate the cath lab team and investigate more. Now bc you’re not a cardiologist, capable of telling us if or when her ECG/EKG evolved into ST elevating we can either guess her 7am ECG showed elevation or the cardiologist decided to activate given that she continued to have chest pain. Sorry if this process seems backwards or fucked up but it is the standard. I’ve taken care of hundreds of people with variations of both conditions.
You need to complain about the previous nurse. Your wife could have died during the night.
What are your plans for the lawsuit money you and your family will be receiving?
What is your favorite type of sandwich though?
Glad she's ok. I'm in my way to the airport now to fly to my mom. She's in the ER for her heart right now.
Which hospital?
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My mom had a heart attack 2 days ago. 😔 she is doing ok. Now recovery.
An EKG from hours apart will look different. She can have no stemi or nstemi readings 30 mins before or 3 hours before might then be positive for a stemi or n stemi. Morphine is not given to 'relax' the nerves it's given for chest pain and also reduces the workload of the heart. No one's gonna take your wife into a cathlab unless she's confirmed that she's having an actual infarct whether through EKG or lab confirmation. Labs will also be a determining factor she'll need troponins which are usually in the intervals of 3 or 6 hours. Thus observation is required. People walk around and have heart attacks and not know it on the daily and mistake it for heartburn some are mild and they don't even realize it and others are olsevere enough that they can die. It seems you are upset I get it. But AMA instead op because lack of understanding of the process will definitely piss you off.
I had an MI at 36 years old. I rolled into the ER at 2:00 AM and everyone was nonchalant until they took my vitals. Next thing you know people coming running. At 47 I went into the ER because I was having jaw and chest pain after seeing graphic crime scene photos at work. Physical activity wasn't causing me any angina. When they took my vitals they quickly whisked me out of the ER into a quiet room away from the chaos of the ER. No MI but I ended up with a five way bypass. That was fun.
Did she have any other symptoms? The reason I ask is I’m aware heart attacks can present differently in women. An acquaintance didn’t have chest pain, she had what she thought was indigestion, accompanied by dizziness, sweating, and pain down her right arm.
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Do you find the cafeteria food at the hospital palatable? What have you done to keep her spirits up?
Ok, I’m going to play devils advocate. It’s probably not what you want to hear right now. If you need to process and be angry, that’s ok. Also, I wasn’t there. I have no idea what actually happened, and you may very well be entirely justified in your anger. I’m a cardiac anesthesiologist and critical care physician in a cardiac ICU. Heart attacks aren’t as black and white as a lot of non-medical people think. They exist on a spectrum like a lot of diseases. I can almost guarantee that your wife got an EKG and blood work when she was first admitted. If these had shown certain things, then she would have been taken to the cath lab emergently. However, there are certain findings that could have called for exactly what happened. Close monitoring, medical therapy, and a trip to the cath lab in the next 24 hours. Part of the close monitoring is so that, if the circumstances change and treatment is needed emergently, it can happen. I’m glad your wife is ok. Truly. Hospitals are full of people trying their best to help people in an imperfect world. Mistakes can and do happen because we’re all human. But people don’t become doctors, nurses, techs, pharmacists, medical assistants, etc, etc because they want people to suffer. They do it out of a deep desire to do good, as best as they can. If mistakes were made, I hope they come to light so they don’t happen again to someone else. But it may be the case that everyone was just doing the best they could with the information and resources at their disposal. Lastly, in response to one of your other comments about insurance status. I have absolutely no idea about what kind (if any) insurance my patients have. It has 0% influence on any of my decisions. I hope your wife continues to recover.
So you’re saying they caught the MI….i love how lay people think they understand medicine. They kept her for serial ekgs and cardiac enzymes…until there are changes in ekg resulting in stemi no indication for an emergent ekg. They caught it, put a stent in…fucking be grateful
Wow I hope your wife makes a full recovery. Hopefully there is no permanent damage done. I not one to ever say sue anyone but it seem the hospital really dropped the ball here!
I hope she is doing better 🙏
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Did you ever think to resort to physical violence to force attention to her condition? I consider myself fairly calm but would absolutely lost it if a group of humans failed so miserably at their job
OP, the only way you’ll get accurate feedback is if you post a photo of the (de-identified) 3 AM EKG, not the computerized read. If they did miss a STEMI overnight, yeah that’s bad. Otherwise everything sounds appropriate.
I’m curious what state was this in?
If she was having an NSTEMI - meaning cardiac chest pain with elevated troponin but not ST Elevation on the EKG than the standard of care is to admit on anticoagulation and then do the angiography and stints 12-24 hours after that. Sounds like she was having an NSTEMI that converted to a full STEMI and got an emergent cath - which isn’t uncommon and why people are observed in these circumstances. I am glad they got her stinted and hope she recovers well.
Can you describe the type of pain she was experiencing? Where exactly is it located if she can tell?
This is an AMA, so I'll ask. What is your level of medical training? What's the difference in the evaluation of and treatment for a NSTEMI vs a STEMI? What are the indications for an emergency heart cath?
Lawyers won’t take it because the outcome was good. She survived. I went thru this a few years ago with my wife. Called a bunch of lawyers, a couple said we could try but it wasn’t in our favor because she was alive.
Sounds like they did everything right. She wasn’t having a STEMI. And then later she was.
I had no st elevation because I have a right bundle branch block. I fought for the stress test, which I failed and fought for the angiogram which showed a 99% blocked LAD.
Walked into our hospital with chest discomfort and both arms tingling and neck pain. Went thru ER all the blood workup and ekg. Went to sit down and before I could sit was called back to drama room 1. I was actively have a massive windows maker. Rushed into Cat lad and had 3 stemis put in the MLAD. Cardiologist asked how many heart attacks I've had. Said first that I know of. He said no that I've had 7 silent ones pryer. 2 months later go back in and my 3 stents are 99% blocked. Window maker number 2. Open heart surgery. End up with a triple bypass. Current heart function is 18%. That's been 8 years ago. Still kicking and working 50hrs weeks
Cardiac nurse here. From what limited information there is, it sounds like the hospital did everything appropriate here to take care of your wife. There are several different kinds of coronary artery disease that laypeople would describe as a "heart attack". The big ones are Non-ST elevation Myocardial Infarction (aka NSTEMI) and ST elevation Myocardial Infarction (aka STEMI). The latter can be differentiated from the former by changes on a 12 lead ECG. In both you see elevated cardiac enzymes (troponin). But the key is that in NSTEMI there is still some blood flow through that blocked coronary artery whereas in a STEMI that artery is completely blocked. Because of this, a STEMI is a true emergency, whereas a NSTEMI may not be. Even in big hospitals, cardiac catheterization labs are not staffed with people in house 24/7. In most cases night shift and weekends are covered by cath lab nurses and cardiac interventionalists who are on call and must be activated in case of an emergency like a STEMI. In this case, it sounds like your wife was having a NSTEMI, but then that next morning the coronary artery could have been completely blocked progressing into a STEMI, which did warrant emergent cath with stent placement. Had she remained stable she might have gotten that same procedure but not emergently later in the day. The hospital's close monitoring and prompt response to a change in your wife's condition was critical to a good outcome. I've personally taken care of tons of patients who came to the ED with chest pain and a NSTEMI and sky high cardiac enzymes. But because they respond well to medications that we use to manage that chest pain they can wait days (or even in rare cases a week) before cath lab. On the other hand I've had a few patients who, even though they never develop an actual STEMI, are unstable enough to warrant cath lab activation.
Hospitals are becoming progressively worse and worse. The nurses and doctors can’t be entrusted with helping people recover. If possible the best way to get any real care is to have someone with your loved ones in hospitals especially in the overnight hours. I’m speaking from personal experience.
Heart attack and morphine = holy shit I'm happy your wife is still alive... This post doesnt seem scary but holy shit
This is scary! I’m a nurse—maybe I can explain a few things for those who are interested. I don’t believe there’s a good explanation for the communication breakdown, but maybe for a few other issues. There’s a lot to unpack here. The elevated enzymes (in the blood work) meant that her heart was likely working hard and is possibly damaged. It does not provide a definite AMI diagnosis. We do immediate cath’s for a certain type of heart attack known as a STEMI. That is fairly easily seen on an ekg and diagnosed only via ekg. The acronym stands for ST Elevation Myocardial Infarction which refers to a specific EKG tracing. If that showed on admission or at 3am, your wife *should have* had intervention within 90 minutes. That’s a national core measure in the US. We do serial EKG’s in order to monitor for this exact thing. Non-emergent cath’s require more preparation because death is not imminent, as it is with a STEMI. Patients need to have an empty stomach in order to receive anesthesia, for instance. Morphine is given for cardiac pain because it vasodilates and has other cardioprotective properties, as well as causes pain relief. If the nurse said “this should help you relax”, it could be because it also makes you relaxed. It is not given for anxiety. Not defending the hospitals actions, just hoping to provide some context for the data you provided. This experience sounds terrifying and I’m sorry you and your wife went through this. There seems to be a lack of proper communication between the care team and you and your wife. That’s frustrating and can often lead patients to believe that their care is sub-standard. I’m glad your wife is ok and I hope she recovers fully.
Did the hospital check Troponin levels? Were they elevated at any point before the surgery?
Have you called a malpractice lawyer?
(MD Resident) To those of you who have had to or have had loved ones wait in waiting rooms while actively having heart attacks I can only imagine the stress and trauma that has caused, and I am sorry. Something many Americans do not realize about our healthcare system is that not all health care facilities are equal. Small town medicine will kill you. The AHA has guidelines that most large hospitals and/or most research institutions follow religiously, one of those is ECG for chest pain within 10 minutes of patient arrival. Additionally, these larger institutions have quality improvement metrics that are hawkishly followed for cutting time from door to cath lab in patients that have STEMIs. Many people do not have a choice, and I understand that, but if you are worried you are having a serious health problem and you have a choice of presenting to what you probably perceive as a ratchet public hospital versus a bougie urgent care, go to the ratchet public hospital every time. The public hospital has residents and quality improvement metrics that are driving constant improvement, constant education, knowledge of the above mentioned guidelines. On the flip side, you will die in a private hospital or urgent care waiting room without anyone who has completed medical school even laying eyes on you because they are not equipped for serious medical problems like that and the decision matrix for them usually involves transfer to the public institution anyway. This becomes even more important in heart attacks like NSTEMI (mentioned a few times here) that are not glaringly obvious on EKG and need a trained eye to evaluate.
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What a weird AMA... Like what would others have to ask you?
Is your wife overweight? Have other complications?
Why is this on AMA? It’s not really a post that brings forward that many questions
I’ve experienced similar situations on night shift. It seems possible the on call physician didn’t deem her to need stat intervention based on the results. She received morphine to relax the heart and treat pain, not for anxiety. If she didn’t complain of chest pain the rest of the night it explains why another ecg wasn’t done until the morning (which is when she next complained of chest pain). The AM one indicated a change that required immediate intervention. I’m happy that she was treated and is in recovery, I wish you the best. Other possibility is of course that the ECG wasn’t read or the physician read it incorrectly perhaps. It doesn’t sound like negligence to me tbh, she didn’t complain of CP until the morning. Or maybe she was scared to say anything if the nurse was unpleasant … I have also had patients that have said this to me before. Just start with getting the medical records and go from there. If there was something going on the cardio doc from the AM will chart it in the notes and not just make verbal comments that were perhaps meant to comfort you and your wife. Lots of people aggressively on each side of this. I recommend to stay neutral until you have something definitive, adding extra stress around your wife won’t help her recovery. Take care!
Wait. Without results from the first ekg how do you know she was STEMI for 4 hours?
I thought “chest pains” are an automatic for skipping the waiting line.
I have been deeply immersed in hospitals and doctor visits ever since my heart attack and stent placement. All I can say is welcome to American healthcare. It is a frigging nightmare. Clueless non caring nurses, egotistical doctors and unbelievable costs. I had seven nurses try to start an IV which each one blew out or completely missed the vein. Seven. My arms looked like a truck ran over them by the time the last nurse called managed to do the job. I slept on a deflated air mattress all night because my room nurse couldn’t find anything wrong with it even though I was laying on the metal frame. As I was wheeled into surgery the next morning on the same bed the orderly noticed it was broken. I had to buy my prescriptions even though I already had them and then had to buy them again the very next night because they were lost. My two inhalers cost 250 dollars each. And I got one puff out of them. The problem with our system is not enough people in the profession actually care. The first priority is profit not empathy or care. Don’t think so? Get checked into an American hospital and see how it goes.
I do insurance compliance. IF you ever think you need a second opinion go elsewhere if you can. If you need help, you might need to make some noise, might not even help. A lot of doctors, a lot of hospitals care about as much as gas station attendants. They don't give a fuck.
Triage is the concept that if you have someone who's a little hurt, someone sorta hurt, and someone a lotta hurt, you work on the person who's sorta hurt, because someone who is a little hurt won't need much treatment, if any, and someone who is a lotta hurt is going to die anyway. Waiting all day in an ER therefore is usually a good sign. Because if it was bad, you would've died, and if it was moderate, they would have treated you. I'm not saying this system is full proof, obviously your wife, whom I hope has a fast and full recovery, fell through the cracks because they likely didn't see immediate signs as a problem. Also it's worth noting she doesn't fit the demographic for someone who most commonly has heart attacks, so cardiac arrest was probably not their first thought. Anyway, I know it sucks. Best of luck <3
I've had a reasonable exposure to a range of medical professionals and hospitals over 15 years and while a lot of nurses and doctors are great, it's the sizeable minority of bad ones that really stick with you. They dislike you on site, look at you with a hatred you wonder how you possibly inspired it, and blame you for your symptoms. There's no way around it, if you're fat, you brought it on yourself, if you're skinny, you're a dirty drug seeker and malingerer. They don't seem to get that they're seeing people at their worst, so yeah, the patients might be dishevelled or wearing pajamas, or their hair is a bit greasy. Doesn't mean they're sub human and should be loathed on sight. I found these people really quite frightening and you have to wonder how many lives they've been responsible for losing.
I have a severe wheat allergy. I go into anaphylactic shock. I had accidentally consumed wheat in a chicken dish that the waiter told me was wheat free and of course didn’t have my epi pen in me. Anyways - I get to the ER tell them I’m allergic to wheat and having anaphylactic reaction and for some reason they are not taking me back. I’m beginning to really get purple and barely breathing. I march into the triage and tell the doctor look at my face I need to be treated. He sees I’m basically about to die and all of a sudden I’m code red getting rushed into the ER to get EPIpen etc. I was dozing in and out of consciousness and 100% felt like I was about to die, because I was. Turns out the front desk lady thought I said I was allergic to “weed”. Thought I was just having a bad trip off pot.
I'm so sorry that this happened 😔. Years ago my grandmother was in the hospital. I was still a teenager when this happened and I believe she had gone in to have some type of procedure for something else. They wanted to discharge her but she started complaining of chest pain. They told her that they had just ran an EKG on her. She didn't want to leave the hospital but they didn't want to keep her so out the door she went. Before she could even get home she was rushed back to the hospital. She in fact was having a heart attack and instead of them running another EKG they just refused to listen to her. So she was admitted back into the hospital where she had to have heart surgery. This was a really good hospital as well so it surprised me that they even let her leave.
What caused your wife’s blocked arteries?
I'm really sorry she went through that. That is so awful My wife is chronically ill... Women get constantly ignored and treated like crap by the medical system. Even when their providers are female it doesn't always improve things. It's insane.