Coronary & ischaemic

Coronary artery disease & angina claims.

Expert witness reports on underdiagnosed, mismanaged or late-referred angina — often the prelude to a preventable myocardial infarction.

Instruct a cardiology expert Call 0800 161 3395
  • Stable & unstable angina
  • Delayed referral
  • Risk factor management
  • Bolam · Bolitho
what we cover

The condition and the legal questions it raises.

Coronary artery disease is the narrowing of the coronary arteries by atherosclerotic plaque, often presenting as stable angina before progressing to acute coronary syndromes. With timely diagnosis, structured risk-factor management and revascularisation where indicated, the trajectory is largely modifiable.

Most instructions arise where the diagnosis was missed or delayed in primary care or the emergency department, where chest pain was misattributed to a non-cardiac cause, or where investigation and cardiology referral did not follow a suggestive history. The decisions are tested against NICE CG126 for stable angina, and NICE NG185 where presentation progressed to acute coronary syndrome.

  • Breach questions address chest pain assessment, ECG interpretation, exercise testing or CT coronary angiography decisions, and the threshold for cardiology referral.
  • Causation questions turn on whether earlier diagnosis would have led to revascularisation or optimised therapy, and whether that would, on the balance of probabilities, have prevented the subsequent MI or other ischaemic event.
  • Risk-factor management — antiplatelet therapy, statins, blood pressure control and diabetes management — sits squarely within primary care responsibility and is frequently in scope.
  • Apportionment arises where pre-existing coronary disease contributed to the outcome alongside the alleged breach — material contribution is then 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 chest pain history was assessed for cardiac features consistent with typical or atypical angina, and whether the differential adequately considered ischaemic causes.
  • Whether resting ECG, exercise tolerance testing, CT coronary angiography or stress imaging were appropriately requested and acted on, in line with NICE CG126.
  • Whether the threshold for cardiology referral was met and acted on within reasonable timeframes, including same-day referral where unstable features were present.
  • Whether antiplatelet therapy, statins, beta-blockers, nitrates and risk-factor optimisation were initiated and reviewed in line with current practice.
  • Whether, on the balance of probabilities, earlier diagnosis or intervention would have changed the outcome, with material contribution analysis where appropriate.
Out of scope

Not covered without separate instruction

Common cases

Common scenarios we report on.

These patterns recur in coronary artery disease and angina claims, most turning on primary care decisions or emergency department triage.

  • Primary care · Misattribution

    Cardiac chest pain attributed to musculoskeletal cause

    Patient presented to the GP with exertional chest pain. Symptoms were attributed to musculoskeletal strain without ECG or cardiology referral, and an MI followed weeks or months later. The report addresses whether the history described typical angina and whether NICE CG126 thresholds for further investigation were met.

    Often paired with: Breach of Duty Causation

  • A&E · Triage

    Unstable angina discharged from A&E

    Crescendo angina or rest pain on presentation; troponin negative on first sample; patient discharged without cardiology review or repeat troponin. Acute coronary syndrome followed within days. The report examines whether the symptom pattern warranted admission and serial testing per NICE NG185.

    Often paired with: Breach of Duty Missed MI

  • Primary care · Risk factors

    Inadequate risk-factor management

    Known coronary disease or multiple risk factors with suboptimal antiplatelet, statin or blood pressure management over an extended period. The report addresses whether long-term management fell below the accepted standard and whether optimised therapy would have altered the event rate on balance.

    Often paired with: Screening & Merits Breach of Duty

  • Delayed referral

    Stable angina — delayed cardiology referral

    Stable angina was recognised but cardiology referral was made by routine rather than urgent route, or investigations were not requested in line with CG126. The patient progressed to an acute coronary event in the intervening period. The report tests the referral threshold and the likely benefit of earlier specialist assessment.

    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?

Instruct an expert in coronary disease and angina.

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.

Instruct a cardiology expert Call 0800 161 3395

GMC-registered consultants Fixed fee where the bundle allows LAA rates available