CASE IN POINT

CAD LEADS TO RECURRENT MI

The plaintiff sustained his first myocardial infarction (MI) many years ago, when he was in his late 30s (Fig 1-1). After his diagnosis and treatment for coronary artery disease, he subsequently lived symptom-free for 4 years.

Fig 1-1 --- Click on Images to Enlarge
Four years later, the plaintiff was diagnosed with another MI. An angiogram identified multiple blockages of major coronary arteries, and bypass surgery was recommended. Shortly after, he underwent a successful quadruple bypass surgery
(Fig 1-2).
Fig 1-2
Fourteen years later, the patient presented with symptoms of recurrent coronary artery disease. A cardiac catheterization was performed that showed occlusion of the grafts from his bypass surgery 14 years ago.

PLAINTIFF'S CLAIM:

The wrongful death of a 56-year-old man was due to an alleged significant delay in the diagnosis and treatment of recurrent coronary artery disease, thereby allowing his condition to progress to the point that he suffered another myocardial infarction (MI, heart attack) and died.

DEFENSE'S ARGUMENT:

The plaintiff had a history of coronary artery disease that was followed appropriately and treated with both non-surgical and surgical options.

The plaintiff's recurrent disease and subsequent treatments were not due to the previous care of his physicians and surgeons. Rather, the recurrent MIs resulted from the plaintiff's unwillingness to change his lifestyle, ultimately resulting in his premature death.

VISUAL STRATEGY:

IV worked with the attorneys and experts to develop a visual strategy that would help explain to the jury in detail how the plaintiff's procedures were done appropriately and without error. Also, IV illustrated the extent of disease that was seen on the plaintiff's 2002 catheterization.

We began by showing normal anatomy of the heart and location of the coronary arteries to orient the jury. (Fig 4-1)

Fig 4-1

 

The cardiology expert who we worked with on the case had created sketches of the patient’s coronary system for use in court. (Fig 4-2, 4-3)

Fig 4-2
Fig 4-3
 

From those sketches we created informative illustrations that were used to help the jury understand the plaintiff's complex system of heart disease and coronary bypasses.

  • The first illustration based on the expert’s sketches detailed the plaintiff’s condition on 4/28/88. (Fig 4-4)

  • The second illustration was of the plaintiff's 6/6/88 quadruple bypass, which showed how the grafts were placed and their intended purpose to bypass the blockages. (Fig 4-5)

  • The third illustration based on the expert's sketches was the 3/22/02 cath findings, which showed total occlusion in two of the four bypass grafts. (Fig 4-6)

Fig 4-4
Fig 4-5
Fig 4-6
 

The illustrations helped the defense successfully convey to the jury the following key points:

  • Since the plaintiff’s first MI in 1984, his coronary artery disease and recurrent MIs were properly treated with both non surgical and surgical therapy.
  • The stenosis found in the grafts on 3/22/02 was no fault of the plaintiff’s physicians and surgeons. Rather, it was the natural consequences of the plaintiff’s unwillingness to change his lifestyle, which allowed his condition to progress.  Ultimately, this resulted in another myocardial infarction that led to his premature death. 

 

RESULT:
The jury found in favor of the defense.  

"Jurors were on the edge of their seats because of the illustration boards. My expert was great in his testimony and this was greatly attributed to the quality of the exhibits."

- Attorney Edward Hinchey, Sloane and Walsh LLP, Boston, MA

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