Aortic emergencies are life-threatening conditions that affect the aorta, the body’s largest blood vessel. They require immediate medical attention. There are 2 types of aortic emergencies that can lead to death if emergency practitioners do not recognise the severity of the patient’s condition, Aortic Dissection (AD) and Abdominal Aortic Aneurysm Rupture (AAA).
What is Aortic Dissection?
Aortic dissection is a life-threatening condition caused by a tear in the tissue layers of the aorta. If left untreated it rapidly progresses and leads to death. Swift diagnosis and treatment is therefore crucial.
HSIB report – Delayed Recognition of Acute Aortic Dissection
In January 2020 the Healthcare Safety Investigation Branch (HSIB) issued a Healthcare Safety Investigation Report into Delayed Recognition of Acute Aortic Dissection. This arose out of a case which is tragically similar to what our client Sharon and her family (see below) experienced three years later.
Richard was a fit 54-year-old man who experienced severe sudden onset chest pain while lifting weights in the gym. Although the pain subsequently reduced, he still felt unwell. After returning home and calling the NHS 111 service, Richard was taken to the emergency department of a local acute hospital by ambulance. The ambulance paramedics believed that the cause of the pain was probably musculoskeletal (from the muscles, bones or joints) but felt there was a need to rule out a heart attack.
After waiting over 30 minutes for triage and, on his case being assigned as priority two (out of five, with one being the most urgent), Richard was placed in a low-dependency cubicle. During his time in the emergency department, Richard was seen by an advanced care practitioner and a second-year trainee doctor. The trainee doctor discussed the case with, and received advice from, a consultant. Richard initially appeared well but his condition subsequently deteriorated with further pain, nausea, vomiting and diarrhoea.
After three hours in the department with no clear diagnosis, Richard was referred to the on-call medical team. The medical registrar was concerned about the possibility of an acute aortic dissection and requested an urgent computed tomography aortogram (CTA) scan, which confirmed the diagnosis of an extensive aortic dissection. After an hour waiting for a formal report of the scan, Richard was sent by ambulance to the regional specialist centre for heart and chest surgery but suffered a cardiac arrest during the journey and died.
The HSIB report found that the medical professionals treating Richard did not recognise sudden onset severe chest pain as a symptom typical of acute AD and noted a lack of awareness of the symptoms and signs of aortic dissection.
Richard was seen only by junior medical staff and there was a delay in escalating his case.
In his case there was a delay of around 4 hours in hospital before a diagnosis of acute aortic dissection was made. HSIB found this delay to be not unusual.
HSIB found that a delay in diagnosis of acute aortic dissection occurs in around 16 – 40% of cases and that acute aortic dissection is one of a number of low-frequency but high-risk conditions recognised as more likely to be missed in the emergency department. However there are strategies available which, if used, would reduce the delay in diagnosis and treatment.
Sharon’s story
Unbeknown to Sharon and her family, Sharon’s last memories were made in the Caribbean with her loved ones. It was a special, long-awaited holiday celebrating twenty-five years of marriage to her devoted husband Neale, as well as their joint 50th birthdays. She first experienced chest pains as the plane landed home. She died in hospital the following morning.
Sharon suffered from Loeys-Dietz Syndrome and she advised both paramedics and hospital staff about this. Loeys-Dietz syndrome is a connective tissue disorder that causes aortic aneurysms. On the morning that she returned from holiday she suffered an aortic dissection which was not diagnosed for many hours.
The Coroner heard evidence that at various stages in Sharon’s medical care those treating her failed to ask the right questions and to recognise the severity of her condition. She should have been seen within an hour of arriving at the Emergency Department and be on her way to a specialist centre for cardiothoracic surgery within four hours of arriving at the Emergency Department. In fact, she was there for more than 12 hours before being transferred for urgent surgery prior to which she died.
Her family are now calling for greater awareness of the Syndrome within the NHS to protect others with the condition. They want to stress the importance of educating people, particularly in the medical field, about Loeys-Dietz Syndrome and Aortic Dissection and the risks associated with them both, so that a repeat can be avoided in the future. They wish to draw people’s attention to the Think Aorta education campaign Think Aorta | Aortic Dissection Campaign which aims to save lives.
How can we help?
If you have concerns about the diagnosis or treatment of aortic dissection a member of our experienced medical negligence team will be able to get answers and understand what may have happened. To have a free, confidential discussion with a member of our team call us today on 0800 044 8488 or fill in our contact form so we can call you back at a time convenient for you.
Names have been changed in some respects to protect anonymity and confidentiality of those concerned.
