Aortic Dissection Malpractice
One of the most recurrent types of cases that our attorneys have handled involve a failure on the part of a doctor (or doctors) to timely diagnose a patient with an aortic dissection and/or ensure that the patient undergoes emergent cardio-thoracic surgery to repair the dissection prior to its rupture and the inevitable death of the patient. These cases are always extraordinarily tragic because the patient's life almost always hangs in the balance where the difference between life and death can literally be measured in minutes and hours. Sadly, in most every case, the death is preventable had more diligent care been provided.
So what is an aortic dissection? Let's start first with a little anatomy lesson. The aorta is the large vessel that comes out of the heart that is shaped almost like a candy cane. The portion that is closest to the heart is the ascending aorta which leads to the "arch" as the aorta curves around to the descending portion of the aorta. The descending aorta drops all the way down into our abdomen where it connects to various other blood vessels. Think of the aorta like a pipe with three layers. The inner most layer of tissue is called the intima. The middle layer of tissue is called the media and the outermost layer of tissue is the adventitia. The hollow portion of the "tube" is referred to as the lumen. Sometimes people have a genetic condition that causes them to develop a weakness in the intima layer over time. In other people, many of whom have long-standing/chronic hypertension (high blood pressure), the force of the blood through the aorta results in an area of weakness in the intima. This weakness, in turn, leads to erosion of an area of intima. The erosion results in a small tear and separation (dissection) of the inner most lawyer and the middle layer of the aorta creating what is called a "false lumen" (a false passageway for the blood). Because blood is being continually pumped through the aorta, some of the blood will naturally flow into this small tear/false passageway for which there is no exit. Pressure builds up as a result. As the blood-filled channel gets bigger and larger, eventually the pressure becomes to great and the aortic wall ruptures, resulting in a catastrophic loss of blood into the area around the heart chamber. This loss of blood causes other organs to be deprived of the necessary oxygen rich blood and can fill the heart chamber to the point where it compresses the heart and impedes its ability to beat. In nearly every instance, the rupture is fatal.
Based on the foregoing, health care providers are taught to recognize the hallmark signs and symptoms of an aortic dissection so that it can be treated prior to rupture. If diagnosed timely, aortic dissections are either repairable surgically or medically, depending on the location of the tear. In most instances, survivability can change (greatly enhanced) from hour to hour.
So what are the typical signs and symptoms of an aortic dissection? Here is a brief list: (1) shortness of breath; (2) severe chest or back pain - patients often have described the pain as being stabbing, tearing or ripping in nature; (3) the sudden presence of weakness or paralysis; or (4) loss of consciousness. Perhaps the most important symptom is the description of the pain. Whenever a patient comes into an emergency room with a complaint of severe chest pain, health care providers should attempt to rule out the three potentially imminently fatal diagnoses that are characterized by severe chest pain: (a) heart attack; (b) pulmonary embolism; and (3) aortic dissection. Thus, aortic dissection should never be far from a physician's mind when a patient is complaining of severe chest pain. Whereas a heart attack is typically ruled out by certain blood tests and or an EKG, an aortic dissection and pulmonary embolism can only be ruled out by employing various radiological studies.
For an aortic dissection, the first diagnostic step that physicians should normally take is to order a transesophageal echocardiogram (TTE for short). This is a test that utilizes sound waves to create an image of the heart from outside the body. A TTE, however, has limitations and thus doctors will, if there is any doubt, order more sensitive radiological studies such as a CT angiogram (with dye), and MRI or a transesophageal echocardiogram (TEE for short) (a study in which a tiny camera is dropped down the patient's esophagus near the heart and aorta to see if there is a tear in the aorta. Comparatively, the CT angiogram and MRI are less invasive. The CT angiogram uses x-rays to give doctors a cross sectional view of the body after the contrast dye illuminates the heart and artery. The MRI is used to make pictures of the aorta using magnetic fields and radio wave energy. The TEE, CTA and MRI area all generally regarded as being more sensitive and better diagnostic tools than the TTE.
So what happens if a tear and false lumen are identified in the aorta. As mentioned above, the treatment depends on the location of the tear. If the aorta has a tear in the ascending aorta or the arch, this is what is known as a Type A dissection and the treatment is almost always URGENT surgical repair. In many cases, patients are life-flighted by helicopter to heart centers that have cardio-thoracic surgeons who are waiting to perform this type of surgery. By contrast, if the tear happens in the descending aorta traveling away from the heart, it is called a Type B dissection and the treatment is often to treat the tear medically with medications like beta blockers to reduce the heart rate and lower the blood pressure so as to prevent the dissection from getting bigger. In some cases, however, surgical repair of the descending aorta is still necessary.
At STSW, our attorneys have successfully several cases in which doctors have negligently failed to timely diagnose or treat aortic dissections. In many instances, patients' lives could have been saved had doctors suspected aortic dissection and transferred the patient to a facility that could perform the surgery emergently. For example, in one case, a man was diagnosed with a possible aortic dissection but not transferred to a facility that could have saved his life for over 20 hours. He died in the helicopter on the way to that hospital. In another case, physicians negligently ignored the signs and symptoms of a clear aortic dissection in a young woman over a period of 9-10 hours. Ultimately, her dissection ruptured and she died without treatment.