Decision Report 201203942

Summary

When Mr C suffered severe chest pains he called an ambulance. The paramedics told him that he was not having a heart attack, but he was taken to hospital for tests. Mr C complained that, despite the paramedics having ruled out a heart attack, he was treated for one upon admission to the hospital. He raised further concerns about a lack of investigation into his chest pain once it was established that he was not having a heart attack, and a lack of follow-up appointments.

We took independent advice on this complaint from one of our medical advisers. The adviser said that paramedics would have carried out an electrocardiogram (ECG - a test to measure the heart's electrical activity and to check for a shortage of blood to the heart muscle). The ECG determines whether the patient is having an ST-elevation myocardial infarction (STEMI heart attack), which suggests a complete blockage of one of the coronary arteries. If such a heart attack is evident, paramedics will take the patient to a dedicated cardiac unit, which may not be the closest hospital. In cases of non-STEMI heart attacks (where the artery is only narrowed or partially blocked), the patient will be taken to the nearest hospital and treated with medication while further tests are undertaken. We found that in Mr C's case, the paramedics ruled out a STEMI heart attack and took him to the nearest hospital. He was still considered to potentially have a non-STEMI heart attack and was treated appropriately for this. Ultimately, tests indicated that he had a chest infection and he was treated accordingly. We were satisfied that the board acted appropriately and in accordance with national guidance for coronary artery disease.

We were also generally satisfied that appropriate follow-up appointments were made after Mr C's discharge from hospital. Although one referral to a rheumatologist was not acted upon, we did not find that this had any significant impact on the overall care provided to Mr C.