A 55 year old who was on ACE inhibitor for hypertension came to see his GP with tightness of chest and a sense of breathlessness. His blood pressure was slightly elevated. The doctor then looked at his ECG for abnormalities of rate, rhythm or appearance. It appeared essentially normal to him apart from suggesting mild tachycardia. He did not find changes suggestive of myocardial ischemia or infarction. As the patient was going through a difficult time losing his job etc the GP assumed his symptoms to be arising from panic attacks. He reassured his patient and did not think he needed emergency admission to a hospital.

Two days later the patient came back complaining of chest pain, shortness of breath and nausea. After seeing him, the doctor immediately arranged for emergency admission to hospital. The ECG and blood results done on his first visit were sent to the hospital. Soon after admission he arrested and required CPR. Within an hour of admission he was dead.

The post-mortem examination showed a large saddle embolus in the pulmonary artery causing complete obstruction of the lumen. The left popliteal vein showed residual deep venous thrombosis suggesting that this was the likely source of the fatal embolus.

The patient’s widow sued the doctor for delayed admission for a serious condition. The expert’s opinion was that the initial symptom of the patient should have been considered as potentially life threatening. Also the doctor failed to note right bundle branch block and right axis deviation compatible with pulmonary embolism on the ECG that he had seen. If the patient had been referred to the hospital immediately on his first visit he would have survived.

The claim was settled for a moderate sum.

(This case is also posted in the medicolegal section. It was reported in the MPS case book)