Misdiagnosed Acute Myocardial Infarction

Few words bring more anguish to the physician than “failure to diagnose.” The “missed” diagnosis or “misdiagnosis” has far reaching implications that frequently involves litigation. One of the most common missed diagnoses is acute myocardial infarction. Nationally, up to 40,000 Acute Myocardial Infarctions (AMI) are missed each year. Ten percent of all ED claims are a result of missed AMIs. According to Thomas L. Rosamond, M.D., “…between 1.7 million and 2 million admissions to US hospitals are for the evaluation of acute chest pain, and [only] 30% of patients admitted ultimately are found to have unstable angina or a myocardial infarction…[even with] aggressive [admitting] practice patterns, 2% to 8% of patients with acute MI are discharged from emergency departments inappropriately.”

In their chapter on chest pain found in the American College of Emergency Physicians (ACEP) Emergency Medicine Risk Management: A Comprehensive Review, Gregory L. Henry, M.D., FACEP, and James E. George, M.D., J.D., FACEP, explain the reason for those numbers: “Chest pain problems… have all the elements that make a lawsuit a nightmare. The victims are usually younger and in high earning capacity years, have dependent children, and experience onset of the illness as a complete surprise. No one wants to be told that their spouse has gastritis, then find them dead in bed at home.”