More often than doctors would ever admit, “specialists” who called in to examine patients in hospitals merely stop by the nurse’s station to review the patient’s chart, rather than actually seeing the patient, yet document a physical examination so brief and in such poor handwriting that it is impossible to decipher. It often comes as a surprise to these patients to learn that their chart reflects them having been “seen” by multiple physicians as consultants. This type of medical practice is not only unethical but also dangerous.
This is particularly dangerous when it comes to failure to diagnose and treat heart murmurs which, if missed or untreated may result in catastrophic injury or death to a patient. In such cases, it is important for the patient or family to contact a top medical malpractice lawyer.
Heart Murmurs
Heart murmurs often indicate a valvular problem in the heart. The heart is comprised of four chambers, known as the right and left atria, and the right and left ventricles. Each chamber has a valve leading into an important blood vessel, or in the case of the right ventricle, into the blood supply of the lungs; in the case of the left ventricle, the aortic valve opens during the cycle of pumping a relaxation of the heart to allow blood that has been through the lungs for oxygenation to travel through the entire body, carrying oxygen to the tissues.
The presence of a heart murmur is a significant finding on physical examination, and requires immediate attention to rule out serious, life-threatening conditions such as endocarditis or heart failure.
Endocarditis
A murmur may possibly represent a bacterial growth on one of the four valves of the heart, otherwise known as bacterial endocarditis. Usually, endocarditis is suspected when a patient has evidence of a long-standing infectious illness, coupled with a murmur, and other signs, such as “splinter hemorrhages” in the nail beds, which represent clots thrown off the valve during the pumping action of the heart, as the aorta leads into the body’s arterial system. The arterial system is the portion of the blood circulation that carries oxygen to the tissues. Without the critical physical examination, this diagnosis may be overlooked, and can result in death from an overwhelming blood infection, known as sepsis.
Heart Failure
Another problem that can result from failure to note a heart murmur can be heart failure. The aortic valve opens to a relatively high-pressure system, when compared to the pressure within the ventricle. The pressure equalize during systole, the phase of the heart cycle during which the aortic valve opens to allow the left ventricle to pump out blood against the blood pressure of the arterial circulation. If the aortic valve doesn’t close right away, the pressure remains high in the left ventricle. Since the heart is a muscle, composed of small muscle fibers, which should remain elastic, high pressure in the left ventricle will stretch the fibers much as an elastic waistband will lose its stretch against a constant pull. Heart failure is simply the loss of the ability of the heart to pump efficiently.
Heart failure is manifested by “pitting edema,” or swelling in the feet and lower legs, which leaves a “pit” when you push your finger against it. Other signs of heart failure are shortness of breath when you lay flat, possibly causing the necessity of sleeping in a recliner or upon multiple pillows. Your liver may become distended, and your neck veins may swell when you are reclining.
If you or a loved one have had a diagnosis of endocarditis or heart failure, and your physician tells you that you have a heart murmur, it is worth a look at your medical records to see if this murmur was previously noted and a physician failed to diagnose and treat the murmur. Another potential problem is if a patient suddenly is noted to have a very loud murmur, but has been seeing a physician for several years and has not been noted to have a murmur previously. In each case, this can represent a critical failure to diagnose and treat, and Chicago’s top personal injury law firm, Passen & Powell, can review your medical records to see if you have recourse for injuries.
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