Missed heart disease in Covid19 – what could help prevent this?

Photo by Sharon McCutcheon from Pexels

In my previous blog I wrote about how my brother had died after his heart disease was missed by the medical profession in the Covid 19 pandemic and he was treated for a respiratory infection with antibiotics. You can read the blog HERE

In this blog I would like to reflect on what might have saved my brother’s life, and what might save the lives of others.

The symptoms of heart disease and respiratory infection can be very similar and easily confused. Pulmonary oedema (fluid in the lungs) after a heart attack, and/or when the heart is struggling, can produce a cough, which in my brother’s case was mistaken for a respiratory infection. Heart disease can result in tiredness and breathlessness, which can also be a result of respiratory disease.

So what would have helped my brother and might help others?

  1. It would have been helpful for my brother to have been made aware of the similarities between heart disease and respiratory illness by his doctor or any medic he consulted with. He was in a high risk patient group being a man in his fifties.  Perhaps my brother might have been triaged differently also by the medics he consulted with. This is really important in the pandemic because eyes may be focused in the wrong direction.
  2. My brother’s employers who would have noticed his cough, and advised about heart disease as well as respiratory illness – giving my brother support and advice when he coughed at work, as he had done for two months.
  3. It would have been helpful if when my brother was prescribed antibiotics the symptoms of a heart attack were shared with him with clear advice about what to do if this emergency situation occurred.
  4. When given his medication the pharmacist might have checked with my brother that he understood the symptoms of a heart attack and understood what to do if one happened.
  5. The PIL (patient information leaflet) given with the medication  could have clearly explained the symptoms of a heart attack and advised that emergency help would be needed. Of all the things that might have saved my brother I feel this was the most critical – it was the last chance to save him. Confused about what was happening to him and sadly unable to get through to 111, he reached out to friends and family. None of us could be expected to know the difference between a chest infection and lung congestion due to heart failure – if medics had not picked this up and their misunderstanding only confused us all, and my brother further, along with a great long list of side effects that seemed to explain his symptoms to him. My brother should have been calling 999 not 111. Whether my brother’s heart disease was too far advanced by this stage for him to be helped is not the issue here – as the lives of others might be saved if the disease were less severe.
  6. In my brother’s case, he was prescribed an antibiotic where the course is commonly started with a double dose. Medication and dosage may be important for someone with a severely compromised heart and perhaps other antibiotics might be considered first. This is a matter for others to consider further as I am not medically qualified.

High risk patient populations need information to be able to safeguard themselves from fatal illness and make sense of their symptoms and I only wish that just one of these things had happened in my brother’s case.

In the event of a death due to an infarction I have the following suggestions:

  1. Critical incident protocols when patients have died due to misdiagnosis and incorrect treatment. Learning from cases is important to prevent future deaths and it shows the deceased’s loved ones there is care and consideration given by the medical profession. there was none in this case.
  2. Communication about cardiac related ADRs to be reported – especially to pathologists – so there can be better understanding about the impact of medications. It was distressing for me to come into conflict with the pathologist about my brother’s lived experience of a heart attack after taking medication – because nothing could be found in the literature and the timing of the infarction appeared to be wrong to him.
  3. An investigation into the death/Case Report/Inquest – if the illness was missed and there can be learning for the medical profession.  As a grieving relative I do not feel I should be battling on my own to prevent future deaths – this isn’t my responsibility. Missed heart disease is an issue of national concern and importance that I see on the news almost on a daily basis.

What good will come of my brother’s death for others if it is just put down to natural causes and the case is closed? How many others will die potentially preventable deaths in the same way? At the very least, this last statistic is an important one to be able to evaluate government policies and the capacity of the NHS to adapt to a changing context where medical consultations will not be happening in the same way as before for some time.

Ultimately, it is a political decision about what resources are to be allocated into understanding a death – especially one of natural causes in a pandemic. There have been concerns raised about post mortems not being done – when these are needed to enable learning about illness. Coroners follow rules and regulations – guidance that is laid out – but there may be a degree of variability about how guidance is interpreted by individual coroners – just as the law might be interpreted in different ways by members of the judiciary. Some citizens may have the resources to pay for legal assistance and advice and some may not, and not receive help to put their case forwards.  Citizens should have rights in death to fair treatment. Relatives of a deceased should have rights to fair treatment also. We are the ones who live with the consequences of decisions made. There should be no discrimination about whose death is important and worthy of scrutiny and whose isn’t – and no covering up for an over burdened and struggling NHS put under even greater pressure now.

We are all doing our best and any blame culture will hinder us.  We need to be able to come together to think about when we have failed, or there were misunderstandings that resulted in fatalities, in a way that there can be learning for others in future. None of us could have done more – but we might have done things differently,

Coroners have a hugely important public safety role – and it is one that I have never truly had cause to appreciate as much as I do now. They will be so important in this pandemic for learning about deaths of natural causes.

Finally, if you do have an adverse reaction to any medication please use the MHRA Yellow Card Scheme to report this. Click HERE

Further information about heart disease can be found on the British Heart Foundation website where there is also a helpline to discuss concerns. Click HERE