Written by attorney James E. Girards

Interventional Cardiology Malpractice

Interventional cardiology is a subspecialty of cardiology wherein cardiovascular disease is diagnosed and/or treated using catheters and other hardware inserted into blood vessels of the heart. Successfully performed, these procedures often avoid the need for surgery.

Interventional cardiology is a very fast growing and rapidly developing field of medicine. According to

"Greater incidence of cardiovascular and other chronic diseases due to an increase in the aging population and unhealthy habits such as smoking, poor diet, and lack of exercise are driving the demand for interventional cardiology products used in angioplasty, stenting, and vascular closure procedures. With the population over the age of 65 expected to grow by 50 percent in the next 30 years, the market is poised for greater growth. Innovative products such as drug-coated coronary stents, rapid exchange balloon catheters, and novel vascular closure devices are providing new market opportunities. * * * The cardiovascular sector is the largest and fastest growing medical device market in the world. According to the analyst, "Increasing synergy between devices and imaging modalities, drugs, biotechnology, and information technology are leading to revolutionary therapies that directly contribute to improved outcomes. For example, there has been a 40 percent decline in mortality rates from coronary heart disease since 1980 due to breakthroughs in interventional cardiology."

Typically, the medical work-up that results in a coronary intervention is part of a two-stage process: 1) the diagnostic catheterization, wherein the coronary arteries are visualized on x-ray, and 2) the coronary intervention itself, which may involve use of a balloon and/or a metal wire stent to open a constricted coronary artery. Typically, a patient comes into this type of care when there is reason to believe he or she may be having a heart attack.

The diagnostic catheterization involves the insertion of a catheter through the femoral artery in the leg to the inlet of the coronary arteries where radiopaque dye is injected so that the cardiologist can visualize those arteries under real-time x-ray. This is known as fluoroscopy. During the diagnostic portion of the procedure, the cardiologist looks for such narrowing or other abnormalities. Upon finding strictures in blood flow or other abnormalities that may be corrected by coronary intervention procedures, the cardiologist will typically call in an interventionalist - a cardiologist with the requisite credentials - to perform the intervention. In some cases, negligence in the performance of the diagnostic or interventional portions of such procedures results in permanent damage to or the death of the patient.

In one common scenario, a patient may present to an emergency room complaining of chest pain. A cardiac work-up is started that typically includes serial EKGs and cardiac enzyme tests - and the patient is diagnosed with a coronary syndrome or a possible heart attack. This patient may be taken to the hospital's cardiac catheterization where the diagnostic catheterization is performed. Upon diagnosis of a stricture of sufficient size, an intervention may follow such as insertion of a balloon catheter to open the stricture and placement of a metal wire stent to hold the artery open. Frequently, it is the manipulation of the hardware that causes injury to the patient. In these cases, the failure of the interventionalist to timely diagnose and treat the injury results in death.

In the flouroscopy sequence of images one thing to look for is a small plume of dye escaping from the coronary arteries. This can be caused by perforation of the artery with the guidewire. If the interventionalist fails to diagnose this problem the patient may die of cardiac tamponade - a condition in which blood collects outside the heart but inside of the membrane surrounding the heart. This restricts the hearts ability to pump and death typically results in a few minutes in this setting.

In other cases, medico-legal issues may range from injuring a patient during an intervention that was not indicated in the first place to failure to properly anticoagulate the patient during and after such a procedure. As in other medical negligence cases, appropriate experts must be retained and the relevant records reviewed in order to determine whether appropriate standards of care were used and for appropriate causation analyses.

In conclusion, it is incumbent upon trial lawyers to be familiar with this area of medicine in order to be able to identify situations that require a closer look so that meritorious cases can be identified and pursued in order to assist those wrongfully harmed.

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