Cardiology Malpractice Cases: The Clinical Framework for Pre-Litigation Evaluation

Cardiac cases represent a significant portion of plaintiff medical malpractice intake and a wide spectrum of viability. At one end are missed myocardial infarction cases with clear documentation failures and direct causation. At the other end are cases where an adverse cardiac outcome occurred despite care that was within the standard.

High-Merit Cardiac Cases

**Missed myocardial infarction in the emergency setting.** The missed MI is one of the most litigated cases in emergency medicine and one of the most consistently viable when the documentation supports it. The viable case has a specific anatomy: a patient presented with a complaint that should have triggered a cardiac workup under the applicable risk stratification tool, the workup was not performed or was inadequate, and the patient suffered a cardiac event as a result of the delay.

**Failure to recognize and treat STEMI.** ST-elevation myocardial infarction has a defined door-to-balloon time standard. Cases where a patient presented with STEMI, the diagnosis was delayed, and the door-to-balloon time exceeded the applicable standard are among the clearest cardiac cases. The myocardium lost during the delay is quantifiable.

Where Cardiac Cases Collapse

**The atypical presentation.** Many MIs present atypically, particularly in women, diabetic patients, and elderly patients. Atypical presentations with jaw pain, back pain, nausea, or dyspnea without chest pain are well-documented in guidelines. A provider who did not consider cardiac etiology in an atypical presentation may have a defensible argument depending on the specific clinical picture.

**The pre-existing cardiac disease problem.** Patients with significant pre-existing coronary artery disease who suffer a cardiac event may have outcomes substantially determined by their underlying disease rather than by the specific episode of care. The baseline cardiac function and the extent of prior disease are relevant to causation.

What Clinical Screening Provides

Cardiac cases require a reviewer who understands the risk stratification tools used in emergency and inpatient cardiology, the documentation standards for cardiac presentations, and the causation arguments specific to myocardial injury. The timing of the event, the documentation of the workup or its absence, and the quantification of myocardial damage relative to the delay are all clinical questions that determine viability before an expert is retained.

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