Be Aware of the Risk of Sudden Cardiac Arrest That Killed “Tony Soprano”

Healthcare providers need to be on alert for the risk factors of sudden cardiac arrest (SCA), the condition that killed James Gandolfini, who played mafia boss Tony Soprano in the hit TV series The Sopranos, and a condition that appears in many malpractice cases.

SCA is the unexpected loss of heart function, breathing, and consciousness. In SCA, the electrical system of the heart fails and, at times, a heart attack may occur concurrently.

About half of people who suffer SCA had no previous symptoms, such as fatigue, dizziness, and racing heart rate. Approximately 325,000 people in the U.S. die from SCA annually. People who smoke or have coronary artery disease, have had a previous heart attack, have high cholesterol, and/or have a family history of heart disease have a higher risk.

These malpractice claims are representative of claims involving SCA:

  • A 52-year-old patient had heartburn for over a week, and her physician treated this symptom. The patient had high blood pressure, elevated blood glucose, and normal cardiac enzymes. Her father had died at age 55 from a heart attack, and she had a family history of coronary artery disease. The physician only considered the diagnosis of heartburn and did not order serial cardiac enzymes, an EKG, or a cardiac consult. The patient died the next day from SCA.
  • An obese patient had elevated triglycerides and complaints of burning in the chest with walking, but no shortness of breath or radiation of the burning sensation into the upper extremities. The physician had done an EKG a year earlier, which was abnormal, and did another EKG, which was also abnormal, with a computer reading of possible left ventricular hypertrophy. The physician thought this EKG was normal, as was his examination, but he did order a cardiology consultation. Prior to the consult, the patient died.

These tips can help providers avoid misdiagnosis of SCA:

  • Consider the possibility of advanced cardiac risk in patients who:
  • Are overweight and unable to control their weight with diet and exercise.
  • Have high blood pressure not responsive to medication.
  • Have evidence of erectile dysfunction.
  • Are glucose intolerant.
  • Have consistently high cholesterol levels.
  • Have a history of alcoholism.
  • Take into account other factors associated with SCA, including:
  • Incidence increases with age—men after age 45 and women after age 55.
  • Men are two to three times more likely to have SCA than women.
  • Personal or family history of heart rhythm disorders, congenital heart defects, heart failure, or cardiomyopathy.
  • Use of illegal drugs (amphetamines or cocaine).
  • Nutritional imbalances (low potassium or magnesium levels).

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.


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