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..

I suppose some people here are saying yes, some are saying no, the fact is that follow up blood tests were due is a good thing, it's just such a tragic shame that he then had the sudden "Coronary Thrombosis" and not a typical gradual heart attack ie increasing pain in chest, so he did not have much chance.

This is my ignorance I acknowledge. I don't have any relevant experience.

If OP's dad had an ECG on Friday before his Saturday heart attack... how would that mean the heart attack was prevented. What would have happened to him that prevented the heart attack on Saturday.

The simplest view is that he otherwise didn't present symptomatically as potential heart attack and his underlying atherosclerosis was unknown. Was he on any medication? If not then it's likely this hasn't presented before and so wasn't a risk factor.

If the GP has taken no action then I'd agree with you. But the GP planned a course of diagnostics based on the discussion and risk assessment they had with your dad.

It's also possible that the shoulder pain actually was completely unrelated to a later heart attack.

OP says that he had at least 2 of the important risk factors for atherosclerosis.
I hope someone can explain how a test on Friday would have prevented the heart attack on Saturday.

I hope someone can explain how a test on Friday would have prevented the heart attack on Saturday.

Because if the test had shown he'd needed a stent fitted this could have been done on Friday. I've never worked in a cath lab but the hospital where I do work I know people at risk of a heart attack go straight to cath lab and bypass a&e. These are people who have rung 999 and the paramedics have done an ecg. Cath lab is open 24/7 and people will go straight there to have procedures done, stuff like having stents fitted to widen their arteries (I'm very hazy on the details).

The only way it would have helped is if it was already causing strain on his heart.

They could have rushed hin for surgery prior to the Saturday.

It depends on what your dad said

Short of sending everyone with any kind of shoulder pain to A and E, which are already swamped, it seems he did not have the classical symptoms of a heart attack.

Unless he had gone straight to a and e to get a heart attack ruled out, and even then if they did the tests and they had come back negative they would have just sent him home.

@Rowthe I agree. And my dad did do an awful lot of manual work / DIY still so it was more likely to be put down as muscular I suppose, and blood tests scheduled for the Wednesday as a precaution which unfortunately was too late.

It's just a shame he didn't have pain in his chest or all the way down his left arm (classic heart attack sign)

I will have to just calm my mind and try to accept what has happened.

I think I am just running myself round in circles in my head (overthinker) because my Dad was such a big part of our family and I am grasping onto any reason why he should be in here when in fact it still wouldn't bring him back x

I have a long-standing heart condition and suffer occasional shoulder pain mostly as a result of working in the garden. Active older people can often suffer from muscle pain. It looks as though the GP was following up on the heart issue in a reasonable way, but events overtook it.
I’m sorry to hear of your loss and hope you can find the acceptance you speak of. My own father died suddenly of a heart attack while waiting for treatment for cancer, and I remember what a shock that was.
💐

OP I am so sorry for your loss.

I am not a medic; here’s a very simple explanation I’ve been given about heart attacks and cardiac arrest.

Generally, people have a gradual furring up of their arteries. There may be symptoms as the arteries narrow, but there may be no symptoms at all and some of the symptoms can be vague and misleading. This does happen to most people as they age, to some extent, and we can manage pretty well with a surprising amount of narrowing.

A heart attack is when the artery gets fully blocked, which tends to be a sudden thing, often by a blood clot suddenly gumming up the narrow bit. This completely stops blood getting to heart muscle, so the muscle dies and stops beating properly. If you are unlucky this can be so bad it causes your heart to stop and you can die.

An ECG will ‘see’ a heart attack as it is happening, and can sometimes see if there is old heart damage, (and blood tests will tell you if you’ve recently had damaged heart muscle). If you are currently having a heart attack you will go straight to the cath lab for a stent.

But to detect arteries that are narrowed but not blocked generally takes a series of tests, much more than just blood tests, and those tests will only be triggered if the GP thinks your symptoms sound anything like heart damage. Unfortunately with the NHS pressures at the moment there are waiting times for these tests too.

DH went through this - luckily he was caught in time but it was several months between DH taking his symptoms seriously and getting the stents placed. I suspect that even if the GP had referred OPs dad for a full cardiac work up, from my experience with DH it’s unlikely the tests could have been done immediately, there are waiting times for these tests at the moment like everything else.

I am sorry for your loss and I do totally understand that need to see if it could have been avoided. I lost my dad in his 60s and possibly if care had been different maybe he wouldn't have died. But I did get to a stage where I thought I just had to accept it. Looking for answers, etc wasn't going to change anything and like many others have pointed out medicine isn't always black or white. Maybe one doctor might have done something different to another - but it doesn't mean one was right and one was wrong.

Sorry for your loss OP, I lost my dad earlier this year suddenly and its really difficult. If its on your mind you can contact the practice manager, not loaded as a complaint but just saying you'd like to talk it through or at least just say how you feel. Yes GPs are busy but I'm sure someone will get back to you, if it is something preventable its something they will refresh on too.

@LadyGardenersQuestionTime yes as it happens my Mum has been referred to the cardiologists (this was in September prior to my dad because of chest pains, and she has had a previous heart attack in 2018) and has been told the wait is up to 9 months.

I suppose it is sadly just one of those things, and as other posters have mentioned they cannot refer everyone with shoulder pain to A&E.

I was referred to Cardiology in August and was seen last week. I had the ultrasound echocardiogram in September and my CT angiogram is in a couple of weeks so hopefully the wait won't be too long but I guess it depends on the Trust. I didn't feel like this wait was excessive either as I'm not urgent, it's more down to family risk (and the fact I have a mild dilation).

@CornishGem1975 the wait in Wales in up to 9 months. I think England is up to 4 months.

Ah. I didn't think it was too bad to be honest given the situation we're in.

I had a minor gynae procedure about 20 years ago and that took 6 months to get to the consultant and another 6 months to actually get the procedure

Hi OP
I'm so sorry for your sudden and shocking loss. I lost my mum suddenly to a heart attack too. I had so many questions as I felt (looking back), there were a series of things missed in her care.

18 months on, I've come to realise that for me, this was a 'right of passage' through the denial stages of my grief. Like you, mum's loss felt 'all wrong', like a tornado had just ripped through the heart of our family. She should still be here, bossing us about, organising us, loving everyone who walked through her door. But she wasn't and that didn't compute or make sense.

As time has moved forward, there's still a lot to recover from but I think I have made peace with the idea that steps were missed in her care. It wasn't negligence as such, just that in the middle of covid, so many appointments got shelved and if it had not been for that, her care may have been handled differently.

We'll never know and even we did, it wouldn't bring her back. So our family is now able to focus on bricking up the massive hole that her passing left in our lives. The questions don't seem quite as important now as they did at the beginning.

I wish you peace.

Thank you for your kind words @savingoldbags

@YoBeaches He was on medication for high blood pressure and cholesterol although I believe low dosages.

Hi @Galaxygirl93

firstly, so sorry for your loss, you and your family must feel devastated, and I completely understand you going through the ‘what ifs’.

if the GP had thought the shoulder pain could be cardiac related and done an ecg it wouldn’t have shown anything. It sounds like he was experiencing angina (mine presented initially with just shoulder pain) but the doctor was thrown off the scent by the increased physical activity - for every shoulder pain that’s cardiac related there are 100,000s more that are any number of things completely unrelated to the heart. Many people with high cholesterol and high bp never go on to have a heart attack.

Heart attack symptoms generally seem to be so unlike what is usually described that it makes it really difficult. The heart doesn’t have nerves so it borrows them from elsewhere - neck, throat, back, arms, shoulders, jaws…I had a perfect BP, o2 sats and breathing during my complete blockage of the right coronary artery, truthfully I could have easily not called an ambulance.

@QuebecBagnet you only go to the Cath lab (PPCI) as an emergency if you’re actually having a heart attack. Otherwise checks on the arteries are done as outpatient appointments. A patient presenting with possible angina at an A and E will not be rushed to have an angiogram.

take care, OP 💐

There are definitely blood tests that check the levels of a specific cardiac enzyme called troponin that would have indicated whether or not he had had a myocardial infarction. The issue was that the only symptom he complained of was a sore shoulder. While that is a symptom of an MI, it is almost always accompanied by crushing chest pain, that radiates down the arm and sometimes up into the neck and jaw. He may have minimized his symptoms while talking to medical staff (Not uncommon) but they can only test and check the information they have been given.

I take notice of all of your points, thank you. I am starting to accept that yes a shoulder pain could have been a heart attack or a whole host of other issues, and of course it would depend on the consultation and as he was already on medication for blood pressure and cholesterol, the risk of heart attack for him was lower. It just seems to be very bad luck unfortunately.

Especially as he was scheduled for blood tests just a few days later. :(

I do have a further question though , if anyone can schedule any light, is there a reason why my Dad was invited back for blood tests, and blood tests not done on the spot there and then?

Is it because the GP thought if muscular pain was most likely, the xray would have shown this?

That being said- if the GP had of done blood tests on the Thursday, I doubt the results would have been done by Saturday anyway? As I said I am not medical soo have no idea of timelines. Also remembering this was in Wales and things seem to take longer....

@Galaxygirl93 my surgery send us to the hospital for bloods. They give us a form and we go to the clinic without appointments, it’s a walk in. Generally it’s a few days before the results come back x

Sorry I am repeating what everyone has said!! I suppose the blood tests weren't done on the day as his shoulder wasn't recognised as a heart attack symptom (and maybe rightly so, it was muscular pain and the heart attack happened anyway) and so he was invited back with no urgency.