Missed or delayed MI diagnosis.
Expert witness reports on whether STEMI or NSTEMI was recognised at presentation, and whether the delay altered the outcome.
- Missed STEMI clinical negligence
- Delayed PCI expert witness cardiology
- ECG and troponin interpretation
- CPR Part 35 compliant
The clinical presentation and the legal questions it raises.
Missed or delayed myocardial infarction claims turn on whether the acute coronary syndrome was recognised, whether the ECG and troponin were correctly interpreted, and whether timely revascularisation would have altered the outcome.
Our cardiologists assess the presentation against NICE NG185 and the ESC acute coronary syndrome guidance, and, where the diagnosis was delayed, whether the delay materially contributed to the injury.
- Breach questions address whether the ECG showed ST-elevation or new LBBB, whether troponin was appropriately interpreted, and whether the threshold for immediate PCI or thrombolysis was met.
- Causation questions turn on whether timely PCI would have salvaged myocardium and whether the outcome would have differed on the balance of probabilities. Breach and causation are often split into separate CPR Part 35 reports.
- Fatal cases may require an inquest report, including Article 2 inquests, on whether the delay materially contributed to the death.
- Compliance with CPR Part 35 is critical; a non-compliant report can be excluded and exposes the instructing party to a costs risk.
The clinical questions our cardiologists answer.
Reports address the cardiology decisions in issue against current guidance and the Bolam and Bolitho standard.
Questions addressed
- Whether the presenting symptoms and ECG met the criteria for STEMI or high-risk NSTEMI under NICE NG185 and the ESC acute coronary syndrome guidance.
- Whether troponin results were correctly interpreted, including the timing of serial measurements and the threshold for immediate intervention.
- Whether the threshold for immediate PCI or thrombolysis was met and acted on within the recommended timeframe.
- Whether the delay in diagnosis or intervention materially contributed to the infarct size, left ventricular dysfunction, or other adverse outcomes.
- Whether, on the balance of probabilities, timely intervention would have altered the outcome, including material contribution analysis where appropriate.
Not covered without separate instruction
- Interventional technique during PCI, which sits with interventional cardiology instruction.
- Quantum assessment or care needs, which require a separate condition and prognosis report.
- Examination of the claimant or prognosis evaluation, which requires a separate condition and prognosis report.
- Whether the claimant’s pre-existing coronary disease contributed to the outcome, unless material contribution is specifically instructed.
Common scenarios we report on.
Missed or delayed myocardial infarction claims typically involve emergency department triage, primary care misattribution, or failure to escalate troponin results.
-
A&E · ECG misinterpretation
STEMI misread as benign ECG
Patient presented to A&E with chest pain and diaphoresis. The ECG showed ST-elevation in the anterior leads but was misinterpreted as early repolarisation or pericarditis, and PCI was delayed by several hours. The report addresses whether the ECG met the criteria for immediate intervention.
Often paired with: Breach of Duty Causation
-
Primary care · Misattribution
Cardiac chest pain attributed to indigestion
Patient presented to a GP with exertional chest pain radiating to the left arm. Symptoms were attributed to gastro-oesophageal reflux without ECG or troponin testing, and a STEMI occurred within days. The report examines whether the history met the threshold for urgent referral under the NICE chest pain pathway.
Often paired with: Breach of Duty Causation
-
A&E · Troponin delay
Delayed repeat troponin in NSTEMI
Patient presented to A&E with chest pain. The initial troponin was negative, but repeat testing was delayed beyond the recommended window. A subsequent rise confirmed NSTEMI, but PCI was delayed. The report assesses whether the delay in repeat troponin materially contributed to the infarct size.
Often paired with: Screening & Merits Breach of Duty
-
Fatal · Article 2 inquest
Missed STEMI leading to sudden cardiac death
Patient collapsed at home with chest pain. Paramedics recorded an ECG showing ST-elevation, but the patient was not conveyed to a PCI-capable centre, and a subsequent cardiac arrest was fatal. The report addresses whether the delay in PCI materially contributed to the death for the inquest.
Often paired with: Causation Condition & Prognosis
Report types commissioned for this condition.
These cases typically progress from screening into full liability work, with causation often the central battleground.
-
Pre-action
Screening & Merits Report
A short-form advisory opinion on whether the case has prospects, where the alleged delay is not immediately apparent from the records.
-
Liability
Breach of Duty Report
Full Bolam and Bolitho assessment of whether the ECG, troponin or clinical presentation met the threshold for immediate PCI or thrombolysis. CPR Part 35 compliant and signed by a consultant cardiologist.
-
Often central
Causation Report
Whether timely PCI would have salvaged myocardium or altered the outcome on the balance of probabilities, with material contribution analysis where pre-existing coronary disease is in issue.
Instruct an expert in missed or delayed diagnosis.
Send a short note on the alleged delay with the records bundle. Quotation returned the same working day; fast-track available where the trial window or limitation deadline requires it.
GMC-registered consultants Fixed fee where the bundle allows LAA rates available