Dads Heart Attack- should Gp have investigated heart further?

[Galaxygirl93]

My dear father had a Coronary Thrombosis major heart attack and passed away one saturday evening in October.

What I cannot get passed is that he went to his GP on the Thursday due to shoulder pain, and was sent to the hospital for an xray on the Friday to check if the shoulder pain was muscular.

He was scheduled to have blood tests on the following Wednesday, but sadly did not make this.

I am struggling to accept whether or not the GP should have acted with a bit more urgency?? My Dad was only 61, he did have high blood pressure/cholesterol but was otherwise healthy and fit. I'm thinking maybe should he of been sent to hospital that day for heart investigations? Or is it normal course of action when there's no other previous history of heart problems.

I know its not going to make a difference but would welcome opinions to maybe help put my mind at ease..

If it makes a difference, this happened in Wales.

I'm so sorry for your loss @Galaxygirl93

A few years back I had shoulder pain. I was sent for an xray but it was a few days later. I had blood tests the same day - I had an option to book in at the surgery (but would have been 10 days) or to take the form to the drop in at the local hospital 'whenever was convenient'. There was no sense of urgency, from either the GP or me tbh. None of the bloods were heart related specifically. Mine turned out to be pleurisy.

If he was healthy and fit then I can see why they would think it was muscular or something rather than heart related. I bet patients with similar symptoms will be investigated more thoroughly/quickly in future though.

If you're not happy with how your dad was treated (and it's understandable you're not!) I'd ask the practice to investigate x

I am so sorry to hear about your dad. I'll give you my opinion, I am not a GP but I am a senior nurse in A&E.
Cardiac pain can radiate, classically we are taught that it can radiate to the jaw, shoulder & arm.
Non traumatic L shoulder pain, especially in an older (no offence to anyone of a similar age) patient should trigger a "could this be cardiac" thought.
I would have thought that it would have been reasonable to do an ECG at the GP which MAY have shown heart damage happening. I would assume that all GP surgeries have ECG machines but I may be wrong.
However....a lot may depend on what your dad said to the GP and how he explained his shoulder pain. If the GP was not looking for cardiac signs and if your dad talked about pain on movement then it is very possible that the dots were not put together

Shoulder pain is a classic sign of a heart attack.
add to that sex, age, and his underlying health conditions and yes an ecg and troponin levels should have been ordered.
at least that’s my experience as a retired nurse.

Thanks @ChocHotolate and @fallfallfall . I am not medically educated, so the death certificate has "Coronary Thrombosis" and "Atherosclerosis" showing as the cause of death, I understand the Thrombosis is a clot which is the plaque ruptured, but would the Atherosclerosis potentially show a concern on the ECG?

As I mention he went to the doctors on Thursday and had the Heart Attack on Saturday so I am aware that unless the doctor had of told him to get to A+E immediately, there would have still been nothing that could have changed the outcome. In Wales they are experiencing up to 9 month wait for cardiologist referrals I believe!!

I agree the GP if he’d considered things thoroughly should have done an ecg. Sadly similar happened to a friends dad. He was in his 70s, hadn’t been to the GP in over a decade and went with abdominal pain. Got prescribed heartburn meds and dropped down dead that afternoon. I was shocked that nobody seemed bothered by this, coroner didn’t pick up on it, etc.

It very much depends what was said to the GP about the shoulder pain, how he described it and lots of other features. I wouldn't send everyone with shoulder pain to hospital for a troponin and we don't do them in the surgery (as they take to long to come back and if you're suspecting a heart attack by doing one they should be in hospital.) I'm very sorry for your loss. He was very young.

Oh and, if they did not have an ECG machine in the GP then what would have been the wait for an ECG in hospital? Is it something you can get hold of same day, or is there a wait for this aswell?

I see, so it's not a black and white issue and sadly seems to be quite subjective

I don’t know enough to know if it would have shown up on a ctg but I know our local hospital has a “cath lab” where people come in by ambulance with chest pain/heart attacks/dodgy ecg and bypass a&e, straight to the cath lab for a procedure which Will usually save them. So if it’s needed stents, etc can be done that day.

They can do one in a&e, Dd has had them done by the triage nurse within 5 mins of walking in with chest pain. Ambulances also have them.

Ok, so really if the doctor was fully covering all bases, really they should have checked out his heart a little bit further at the time when my dad visited on Thursday, or advised he visited A+E for an ECG?

Although, I do take into account my dad may have been playing down his symptoms possibly also as we all tend to do this sometimes don't we, and not be too much trouble

I had shoulder pain and no one considered it to be heart related, it might have depended on what your dad told the g.p

In my opinion, he should have had the troponin blood tests at A&E. I went with mild chest pains which they suspected was non-cardiac but they did the blood tests and I had the results back within about 2 hours. They also did an ECG and the GP and A&E. My ECG was done within about an hour of me arriving at A&E.

I am very sorry for your loss Galaxygirl93

I think it does depend on what your dad said to his gp.

I would agree with musicaltheatremums comment - isolated shoulder pain is common and I wouldn't immediately assume a cardiac cause. It does depend on what the GP was told and they should have asked some more probing questions. You can ask the doctor to meet with you to explain.

I think it's impossible to say without knowing what your dad said to the GP, what they asked etc. Previous posters are right that shoulder pain can be a symptom of a heart attack, but in the absence of other symptoms it could also just be a shoulder injury. It's impossible to know how thorough the GP was and whether they missed any questions/symptoms that might have led to an earlier referral. I don't think they'd routinely be doing ECGs on every patient coming in with sore shoulders - and even then a single ECG can be normal in the early stages of a heart attack. Regarding A&E on the Friday - did he just go for the X-ray, or was he actually seen by a doctor on the day?

FWIW, I'm a doctor (not GP) and my dad had left shoulder pain the day after doing some DIY for me. I kind of assumed it was related to the DIY - he's left handed too so had been doing extra work with that arm - and didn't push him to take it further. Two weeks later was in hospital with a heart attack, though fortunately a better outcome than your poor dad. I still kick myself for not realising that sore shoulder was probably the first sign.

I don't think it's unreasonable for you to ask the question to the GP practice - they may want to review it themselves to see if they could have done something differently. You don't need to phrase it as a complaint or anything at this stage, but it's an unexpected death within only a few days of seeing them, so it's not unreasonable to ask. I'm sorry for your loss.

@SockQueen I think he only went to the hospital for the Xray and did not see a Doctor at the hospital.

The fact that he had underlying cardiac disease really should have raised a big flag. Although you thought of him as healthy and fit his coronary system wasn’t.

I think the best thing OP is to try and find out what the consultation with the GP was like. No one here knows what your dad said to the GP. The only people who can tell you is his surgery. One of our A&E nurses had an on/off shoulder injury. When he started getting pain he thought it was that, it turned out it was a heart attack. Sometimes the way it presents doesn’t always follow the ‘normal’ signs and symptoms. Get in touch with his GP and start from there x

Dp went to the gp with shoulder pain and was diagnosed with muscular pain - it wasn't, it was an MI, he survived and contacted the gp regarding the diagnosis if only to try and prevent it happening again.

He was (only) 36 so I presume a cardiac event was not the first thought. He did subsequently speak to the gp and has an apology in his notes.

I'd request a copy of his notes and discuss with the practice manager.

I'm sorry for your loss

I dont think you will see his medical notes and the practice manager would only suggest you speak to his g.p. is there going to be an Inquest, perhaps the Coroners offixe may be able to help you.

Yes but I assume the blood tests on the Wednesday were to maybe check on his heart. What I am trying to ascertain is , should he really have been told to get himself to A&E by the doctor for urgent investigations, or is a follow up blood test normal course of action.