The Afternoon Quandary: Heart Attack Cases After 4 PM

The potential for missed diagnoses and errors is disconcerting, especially when they can lead to fatal consequences
The issue of afternoon heart attack cases has captivated the attention of medical researchers for quite some time.
The issue of afternoon heart attack cases has captivated the attention of medical researchers for quite some time.GK Layout Desk

Reminder: Now, especially post covid nobody is too young for a heart attack. Heart attack cases after 4 pm in hospitals, usually juniors on duty they miss diagnosis which has proved fatal...

An acquaintance of mine, an elderly individual with diabetes, raised concerns about stomach pain and was promptly taken to a hospital around 8:30 PM. He received intravenous injections, and through an abdominal ultrasound, both gall bladder and abdominal issues were ruled out, leading to his discharge.

Subsequently, this man experienced intensified abdominal pain, now extending to his lower chest region. He was rushed back to the hospital, where he underwent examination by a senior doctor on call. Tragically, he was diagnosed with a severe heart attack, but by the time the diagnosis was made, the critical “golden hour” had elapsed, resulting in his unfortunate demise.

In another instance, a 22-year-old youth has sadly passed away due to a sudden cardiac arrest. This unfortunate incident occurred shortly after he returned from one of the hospitals.

His family had taken him there following his complaints of sudden chest pain. Despite being attended to by doctors who conducted an ECG and cardiac markers test, they had initially found nothing abnormal.

This case is not an isolated one; a doctor from a city’s private hospital has expressed concern about a growing pattern of missed diagnoses.

Heart attacks, also known as myocardial infarctions, are medical emergencies that demand swift diagnosis and treatment. However, a troubling trend has emerged within several hospitals.

Cases of heart attacks that transpire after 4 PM appear to be linked with instances of misdiagnosis. This is often attributed to junior doctors on duty.

This concerning pattern raises significant inquiries regarding the standard of care during later hours and the responsibilities of less-experienced medical professionals in critical scenarios.

The potential for missed diagnoses and errors is disconcerting, especially when they can lead to fatal consequences. In any professional environment, particularly in the realm of medicine, ensuring patient safety must remain the foremost priority. Here are a few aspects to contemplate:

The issue of afternoon heart attack cases has captivated the attention of medical researchers for quite some time. Research indicates that heart attacks can transpire at any time.

Nevertheless, there’s a noteworthy surge in occurrences during the morning hours due to various physiological factors, including heightened blood pressure and heart rate upon awakening.

Nonetheless, recent observations propose that heart attacks after 4 PM might present a distinct set of challenges, particularly within hospitals.

Junior doctors, often in the nascent stages of their medical careers, bear the responsibility of overseeing patient care in hospitals. While they are under the supervision of senior doctors, their exposure and experience might not be as comprehensive as that of their more seasoned counterparts. In cases of heart attacks, precise and timely diagnosis is paramount to administering suitable treatments like clot-dissolving medications or interventions such as angioplasty.

Numerous factors contribute to the difficulties faced by junior doctors when it comes to accurately diagnosing heart attacks after 4 PM. Fatigue stands as a significant factor, given the extended hours they might have already worked.

The potential shortage of senior doctors during these hours can also escalate the pressure on junior doctors to make critical decisions. Furthermore, junior doctors might not have encountered as many heart attack cases, leading to a deficiency in experience when recognizing subtle signs and symptoms.

Human Error and Misdiagnosis; During the afternoon hours, a shift change often occurs, potentially leading to communication gaps between outgoing and incoming medical teams.

This transition can result in the oversight or misinterpretation of crucial patient information, thus contributing to potential misdiagnoses. Furthermore, the time pressure and stress associated with managing emergencies can foster cognitive biases and tunnel vision, causing junior doctors to focus solely on a particular diagnosis, disregarding alternative possibilities. Given the potential impact of junior doctors on afternoon heart attack cases, several measures can be taken to enhance patient outcomes.

Improving the training of junior doctors in recognizing heart attack symptoms, interpreting ECGs, and understanding risk factors can substantially enhance their diagnostic accuracy.

To ensure informed decisions, implementing a system that offers continuous supervision and mentorship during evening shifts is crucial. Adequate oversight, especially during after-hours shifts, is essential for junior staff, including doctors and healthcare professionals.

Senior staff or experienced professionals should provide guidance and support, mitigating the risk of errors. Effective communication during shift changes is pivotal, necessitating adherence to proper handover procedures. This guarantees accurate transmission of crucial patient information to the next shift, preventing misunderstandings or omissions.

Standardised handover procedures, such as the use of SMART techniques, can facilitate precise transmission of essential patient information. In instances where juniors are working after hours, establishing a reliable channel for seeking advice or consultation from more experienced colleagues in cases of uncertainty is imperative.

Thorough training of junior doctors should encompass a diverse range of cases and encompass not only medical knowledge but also critical thinking, problem-solving, and decision-making skills. Continuous learning and skill development are paramount for all healthcare professionals.

Integrating technology-based decision support tools can aid junior doctors in diagnosing heart attacks by furnishing pertinent information and guidelines. Technological utilisation is widespread among healthcare institutions, augmenting patient care through digital tools that aid diagnosis, decision-making, and communication.

It’s vital, however, that these tools complement clinical judgement rather than supplant it. Working extended hours in a strained ED environment can result in fatigue and diminished cognitive function.

To counteract this, institutions should implement protocols to regulate working hours, guarantee sufficient rest, and forestall burnout among junior staff.

Elevating awareness among medical professionals about the specific challenges of diagnosing heart attacks post 4 PM can incentivize a proactive stance toward addressing this issue.

Promoting a culture within healthcare organisations that encourages the reporting of errors or near misses without apprehension of retribution is paramount.

This facilitates the analysis of underlying causes and the implementation of preventive measures. In exigent or critical scenarios, established Clinical Practice Guidelines (CPG), algorithms, and protocols should guide junior staff in making swift decisions while upholding patient safety.

If a decade ago, doctors primarily encountered individuals aged sixty and above developing heart disease, these days it’s becoming increasingly common to witness instances of heart attacks among those under the age of 50.

Occasionally, medical professionals even come across cases of heart patients as young as 18 or 19, although such occurrences remain infrequent. While the traditional attribution of heart disease to vices was prevalent, contemporary youth in their twenties and thirties now confront the risk of heart disease due to their sedentary lifestyle, heightened stress levels, dietary habits, and even some unproven conjectures like substance abuse or imprudent usage of anabolic steroids for bodybuilding.

The most challenging aspect for physicians treating young heart attack patients lies in persuading parents who struggle to comprehend how their ostensibly healthy child could develop such a severe ailment as a heart attack at such a young age.

Just last week, a 26-year-old male, a student, was urgently admitted to a state-run hospital after working hours due to intense chest pain. Despite conducting ECG and Cardiac marker tests which yielded normal results, the patient was discharged home.

However, a few hours later, the patient was readmitted to the hospital with the same complaints. During a repeated ECG, the patient reported acute and severe chest tightness, leading to a cardiac arrest. Although CPR was initiated, the patient ultimately succumbed to the condition.

The diagnosis indicated a significant heart attack, causing substantial difficulty for his parents to come to terms with the reality. They continued to assert that he was just 26 and even recounted a recent incident where they thought he had been struck by a cricket ball.

However, the reality was far worse—he had experienced a heart attack, and his condition had deteriorated to the extent that he couldn’t even walk upon arriving at the hospital.

Despite receiving an injection of Pantop in the emergency department before discharge, troponin levels can take several hours to elevate after a heart attack, potentially resulting in undetectable initial test results.

To counter the risk of a false negative outcome, troponin levels are commonly retested over a 24-hour period to monitor any upward trends.

Should you hold concerns about the situation you’ve described, it’s imperative to communicate these apprehensions to the appropriate authorities within the healthcare institution.

Safeguarding patient well-being is of utmost importance, and any issues that might precipitate fatal errors warrant swift and serious attention.

Regrettably, medical errors are not an uncommon phenomenon, carrying profound repercussions for patients. The prevalence of medical errors can significantly differ based on the healthcare system, the type of error, reporting protocols in place, and the criteria employed to classify errors. Notably, not all medical errors culminate in harm to patients.

The issue of overlooked heart attack diagnosis in hospitals, particularly after 4 PM and frequently attributed to junior doctors, underscores the necessity of a comprehensive approach to healthcare delivery.

By addressing challenges encompassing limited experience, communication gaps, and time constraints, healthcare systems can strive to ensure accurate diagnoses and prompt treatment for patients, regardless of the hour.

Through educational initiatives, mentorship programs, and enhanced communication practices, junior doctors can enhance their capacity to manage critical cases and contribute to improved patient outcomes. 

(Author besides being a practising medical doctor practices in Mubarak Hospital, is very active in positive perception management of various moral and social issues. He can be reached at & twitter @drfiazfazili)

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