Patient Suffers Heart Attack After Delayed EMS Arrival

Case Overview

This case involves a 61-year-old female who was at a sporting event at a local field when she felt chest pain and shortness of breath. Because the event was small, there were no EMTs present on site. The woman’s husband called 911, and emergency responders reported they were on the way. There was a delay of several minutes for the EMS to arrive because the ambulance driver was unable to find the field. During this time, the patient became unresponsive. At the emergency room, the patient was found to have an anterior myocardial infarction. She was brought to the cath lab which showed occlusion of the LAD coronary artery treated with a stent. Despite the stent, the patient was found to have suffered an anoxic brain injury.

Questions to the Cardiology expert and their responses

How often do you treat patients with myocardial infarctions?

I treat patients with myocardial infarctions frequently. I am on the inpatient CCU service about 6 weeks a year and the consult service for 4 weeks a year. I spend 20% of my year involved in inpatient cardiovascular where I see at least 6 myocardial infractions a week, with at least 1-2 STEMIs per week on the CCU.

What is the treatment for a patient with an anterior STEMI?

The correct treatment for an anterior STEMI includes aspirin, P2Y12 inhibitor, beta blockers, heparin, high dose statin, and going immediately to the cath lab followed by cardiac rehab along with an echo. If there's LV dysfunction, then we add an ACE/ARB and if there is significant LV dysfunction in an older patient, eplerenone (though spironolactone) can be added. Warfarin can be considered as well if there's significant apical akinesis and stasis on the echo.

How can a delay affect the outcome for a patient with an anterior STEMI?

If cardiac arrest occurs in a patient with an anterior STEMI then every minute is crucial. In that case, several minutes can be a sufficient delay that can result in brain injury if the bystanders cannot provide good CPR or immediate defibrillation. I have reviewed a case with a missed myocardial infarction by hospital staff. I have also managed cases where patients were found down or had an arrest en route to the emergency room where they had a consequent anoxic brain injury.

About the expert

This expert has over 15 years of experience in cardiology. He obtained his BA in chemistry from Princeton University, before receiving his MD from the Vanderbilt University School of Medicine. He then completed an internship and residency in internal medicine at the University of Pennsylvania, followed by a fellowship in cardiovascular medicine at Vanderbilt University. Today, this expert is board certified in cardiovascular disease and is a member of the American Society of Echocardiography and the American College of Cardiology, where he has been elected as a fellow. He is active in academia, having published and presented extensively on topics related to cardiology. He is currently an assistant professor of cardiology at a top medical school, an attending cardiologist at two major medical centers, the director of echocardiography, and the director of the anticoagulation clinic at a VA medical center, all in Tennessee.

E-318577

Specialties:

Cardiology

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.