Inherited & acquired heart muscle disease

Cardiomyopathy claims in clinical negligence.

Expert witness reports on missed cardiomyopathy diagnosis, delayed referral for genetic testing and family screening, and inadequate medical management of hypertrophic or dilated phenotypes.

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  • Hypertrophic cardiomyopathy
  • Dilated cardiomyopathy
  • Missed cardiomyopathy diagnosis
  • Inherited cardiomyopathy & cascade screening
what we cover

The condition and the legal questions it raises.

Cardiomyopathies — hypertrophic, dilated, arrhythmogenic and restrictive — are primary disorders of the myocardium that may present with heart failure, arrhythmia or sudden cardiac death. Timely diagnosis, family screening and appropriate medical or device therapy can alter the trajectory.

Most instructions arise where the diagnosis was missed in primary care or emergency settings, where family screening was not offered despite a known inherited pattern, or where medical management fell below accepted standards. The decisions are tested against the current NICE chronic heart failure guidance and ESC guidance on cardiomyopathies.

  • Breach questions address whether the presenting symptoms — exertional dyspnoea, syncope, palpitations — were adequately investigated with ECG, echocardiography or cardiac MRI, and whether referral to a cardiomyopathy specialist was indicated.
  • Causation questions turn on whether earlier diagnosis would have led to implantable cardioverter-defibrillator insertion, beta-blockade or family cascade screening, and whether that would, on the balance of probabilities, have prevented the sudden cardiac death or heart failure admission.
  • Genetic testing and counselling — a failure to offer family screening where an inherited cardiomyopathy is diagnosed sits squarely within clinical negligence and is frequently in scope.
  • Apportionment arises where pre-existing cardiomyopathy contributed to the outcome alongside the alleged breach, with material contribution analysis central to causation.
Clinical scope

The clinical questions our cardiologists answer.

Reports address the cardiology decisions in issue against current guidance and the Bolam and Bolitho standard.

Included in scope

Questions addressed

  • Whether the presenting symptoms — exertional dyspnoea, syncope, palpitations — were adequately assessed for features consistent with cardiomyopathy, and whether the differential diagnosis considered primary myocardial disease.
  • Whether echocardiography, cardiac MRI or genetic testing were appropriately requested and acted on, in line with current ESC guidance on cardiomyopathies.
  • Whether the threshold for referral to a cardiomyopathy specialist or inherited cardiac conditions clinic was met and acted on within a reasonable timeframe.
  • Whether beta-blockers, ACE inhibitors, mineralocorticoid receptor antagonists, ICDs or CRT devices were initiated and reviewed in line with current practice.
  • Whether, on the balance of probabilities, earlier diagnosis or intervention would have altered the outcome, with material contribution analysis where appropriate.
Out of scope

Not covered without separate instruction

  • Interventional technique during septal ablation or surgical myectomy, which sits with interventional cardiology instruction.
  • Cardiac transplantation decisions, addressed via cardiac surgery instruction.
  • Examination of the claimant or prognosis evaluation, which requires a separate condition and prognosis report.
  • Quantum, life expectancy and care needs, addressed through dedicated reports where the case progresses to that stage.
Common cases

Common scenarios we report on.

These patterns recur in cardiomyopathy claims, most turning on primary care or emergency department decisions.

  • Primary care · Misattribution

    Exertional dyspnoea attributed to asthma

    A young adult presented to the GP with progressive exertional dyspnoea. Symptoms were attributed to asthma without an ECG or echocardiography. Subsequent sudden cardiac death occurred. The report addresses whether the history described features consistent with hypertrophic cardiomyopathy and whether the threshold for further investigation was met.

    Often paired with: Breach of Duty Causation

  • A&E · Syncope

    Syncope in young adult discharged without cardiology review

    Patient presented with exertional syncope; the ECG showed left ventricular hypertrophy but was reported as normal, and the patient was discharged without echocardiography or cardiology referral. Sudden cardiac death followed. The report examines whether the ECG findings warranted specialist assessment.

    Often paired with: Breach of Duty Causation

  • Primary care · Family history

    Known inherited cardiomyopathy — no family screening offered

    Patient with known hypertrophic cardiomyopathy; first-degree relatives were not offered genetic testing or echocardiography, and a relative later died from sudden cardiac death. The report addresses whether the duty to offer cascade family screening was breached.

    Often paired with: Screening & Merits Breach of Duty

  • Delayed referral

    Dilated cardiomyopathy — delayed specialist referral

    Symptoms of heart failure were recognised but referral to a cardiomyopathy specialist was delayed; the patient progressed to end-stage heart failure requiring transplantation. The report tests whether earlier referral would have altered the trajectory on the balance of probabilities.

    Often paired with: Causation Condition & Prognosis

Reports

Report types commissioned for this condition.

These cases typically progress from screening into full liability work, with causation often the central battleground.

Approaching a deadline?

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Send a short note on the alleged failings with the records bundle. Quotation returned the same working day; fast-track available where the trial window or limitation deadline requires it.

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