製薬業界で 12 年以上キャリアを持つ Sharon 先生による医療コラムをお届けします。
特集：医療英語 > Case 1: Acid indigestion or a heart attack? - 胃酸過多か? 心臓発作か? -
57 year-old executive woman presented at her local hospital's emergency room complaining of sharp abdominal pain localized just below the sternum, nausea and dyspnea. She had eaten lunch two hours prior at a local restaurant. The woman is the vice president of human resources at a Fortune 500 company and she remarked to the physician that she had been under a lot of stress because the company had just laid off ten percent of its workforce. She has a sedentary lifestyle and is moderately overweight.
Her vital signs were: blood pressure 150/90, heart rate 110 and respiratory rate 17. The following tests were performed: basic EKG, blood chemistry and cardiac enzymes. The results of the EKG and cardiac enzymes were within normal limits. Her blood chemistry showed a cholesterol level of 285 with all other parameters within normal limits.
The woman was diagnosed with acid indigestion and prescribed antacids. She was discharged and instructed to return if the pain continued. She was also told to follow-up with her primary physician to address her high cholesterol levels. That night the woman died. An autopsy revealed that the cause of death had been an acute myocardial infarction (MI).
The patient did not have a history of acid reflux or other related ailments. It is now well know that women suffering from heart attacks often present with atypical chest pain which appears to be abdominal in origin. With this in mind, the emergency room physician should have expanded his differential diagnosis to include heart conditions. Serial cardiac enzymes and EKG's should have been performed, as it is well known that the enzyme levels and EKG changes characteristic of MI may not appear for several hours. The patient should have been kept under observation for a longer period of time while these additional tests were performed. A patient should not be discharged until a serious potential diagnosis such as an MI can be ruled out.
The patient's family filed a claim against the local hospital and the emergency room physician due to their failure to diagnosis her heart condition.
- Please summarize this case. What is the main point of the article?
- Was the patient's initial work-up complete? If not, what other tests should have been performed?
- Was the emergency room physician's initial diagnosis justified? Why or why not?
- What are some of the differences between men and women suffering from a myocardial infarction?
- Was the emergency room physician negligent? Why or why not?
- Was the hospital negligent? Why or why not?
- What should the hospital do to avoid this type of negligence in the future?