Cardiologist Expert Witness

Cardiology is a medical specialty dealing with disorders of the heart and blood vessels. Cardiology includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians specializing in this field of medicine are called cardiologists. One of AME’s cardiology expert witnesses has written an exclusive medical malpractice article that we have provided, for your interest, below. Complications are frequent in the cardiac catheterization procedure, in which either a cardiologist or a radiologist performs the arteriogram studies. A plastic tube, is passed through a needle, usually into the groin (femoral) artery, up through the aorta, (the main artery of the abdomen and chest) and into the openings of the two coronary arteries of the heart. The radiologists use the same technique to do the arteriogram studies of the neck (carotid) arteries. As the catheter passes up the aorta, cholesterol deposits and blood clot debris, which are often found in the elderly, can break off. These follow the blood flow and often block the arteries to the legs. The patient has to be told of that risk, and then the complication has to be followed up. The dislodging of that debris during the study is often unpreventable as it is a rather “blind” manipulative procedure. If there is a blocked off blood vessel from embolization of this “debris”, then a vascular surgeon is called. Plastic tubes called Fogarty embolectomy catheters, skinny tubes with a deflated balloon around the end are pushed through the clot, inflated and pulled back, removing the clots and debris, and often saving a leg if done timely. After eight hours of delay, irreversible changes will occur to the muscles and nerves. Not only will the clot become hard, but the side branches through which the blood would normally flow to the muscles of the leg become solidly blocked off. Even though the main artery is cleared out, these side branches remain blocked off and they won’t open up to allow blood flow, so the main artery blood vessel has stagnant flow and will clot off again and again. Timely recognition of the complication and prior informed consent is important. If the arteriogram operation is done through the arm,  into the brachial artery, passing the catheter up to the heart area, that brachial artery can become blocked off (occluded) and if it does, timely operative intervention by a vascular surgeon is required. Complications are sometimes unpreventable, but the failure to treat the complications often is clear medical malpractice. Cardiologists rarely misinterpret electrocardiograms (EKGs). Most often misinterpretation is on the part of general practitioners and emergency room physicians. The same is true of misdiagnosis or mistreatment of heart failure, which can be confused with asthma. Any new elderly “asthmatic” must have heart failure ruled out, as this can also cause wheezing and shortness of breath. The damages are usually limited to the suffering from the misdiagnosed condition; not to a permanent worsening of the heart muscle condition. Misdiagnosis of a heart attack is most commonly an emergency room act of negligence and is discussed in that chapter. With the use of recently developed heart drugs (calcium channel blockers) some acute myocardial infarctions can be prevented. Worsening chest pain to the level of incapacitation at rest, increasing frequency, or resistance to Nitroglycerin would require timely institution of these medications. This therapy helps to overcome, to some degree, the “so what” defense to inadequate therapy for severe myocardial ischemia (crescendo angina).