Wrong Medicine Epinephrine Causes Broken Heart Syndrome Lawsuit

Dalessandro v. Shady Grove Adventist Hospital

Patient with IVThis medical malpractice claim was filed in Montgomery County after a woman suffered permanent heart and cognitive damage as a result of a misread prescription. It was filed in Health Claims Arbitration on March 5, 2018, and it is the 105th medical malpractice case filed in Maryland this year.

Summary of Plaintiff's Allegations

After undergoing an elective knee replacement surgery, a woman became mildly hypotensive. A nurse in the post-anesthesia care unit noticed the woman's low blood pressure and requested that a doctor prescribe Ephedrine.

Shortly after a doctor ordered five milligrams of Ephedrine for two doses, a different nurse mistakenly administered Epinephrine instead of Ephedrine. The woman's heart rate and blood pressure immediately rose. She also began to cough and complain of nausea.

The doctor who prescribed the Ephedrine returned to the woman's bedside and determined that she had developed severe hypertension and ventricular tachycardia. He prescribed Esmolol to treat the woman's heart rhythm problems and, after questioning the nurse, discovered the mix-up.

Even after the woman's heart rate returned to normal, her condition continued to deteriorate as a result of the hypertensive episode. She developed Takotsubo cardiomyopathy, requiring critical care and cardiac catheterization. An MRI of her brain also showed a small stroke in the right occipital lobe of the brain.

Ultimately, a prescription reading error caused the woman to suffer a dangerous swing from hypertension to hypotension, a stroke, cognitive damage, and heart damage.

Additional Comments
  • This is the rare medical malpractice cases that involves Takotsubo cardiomyopathy, also known as broken heart syndrome, is a weakening of the heart's main pumping chamber due to severe physical or emotional stress.

  • Why is it called broken heart syndrome? It is frequently seen in patients who have recently lost a loved one.

  • Broken heart syndrome occurs primarily in older women and those with cardiovascular disease are particularly vulnerable to it. The exact cause of the syndrome is unknown, but some experts believe that surging stress hormones, such as adrenaline, can stun the heart and trigger changes that hamper the left ventricle's ability to pump blood effectively. Since Epinephrine is the pharmaceutical term for adrenaline, the theory seems to hold up in regards to this particular case. Will they get a Frye-Reed challenge on the theory that this drug causes broken heart syndrome? Probably. Because there is not going to be any study that supports this premise.

  • What will be the defense to this case? Who knows? But it would not be a surprise if the defendant argues that these drugs are basically the same. Epinephrine and ephedrine alkaloids produce similar effects in the body. So the argument is causation because they are the same. But certainly there are different potencies between the two. Epinephrine is between 41 and 69 times more potent than ephedrine.

  • Take a look at this April 2018 appellate case where the court reverses summary judgment for the defendants. Plaintiff is that case argued that the doctor negligently administered ephedrine to treat anaphylaxis despite the fact that clinical guidelines require the epinephrine. Plaintiff claims that she suffered "a protracted duration of intraoperative hypotension… that resulted in an anoxic brain injury…"

Jurisdiction
  • Montgomery County
Defendants
  • Adventist Healthcare, Inc. d/b/a Adventist HealthCare Shady Grove Medical Center a/k/a Shady Grove Adventist Hospital

  • Two registered nurses

Hospitals Where Patient was Treated
  • Shady Grove Adventist Hospital
Negligence
  • Failing to follow the accepted standard for nursing procedures and safety methods for ensuring that the correct prescription was obtained and administered.

  • Administering Epinephrine, a drug that was not ordered for the claimant.

Specific Counts Pled
  • As a direct result of the defendants' negligence, the claimant suffered a coronary artery spasm, ventricular tachycardia and hypertension, morbid hypotension, myocardial ischemia, Takotsubo cardiomyopathy, a stroke in the right parietal region of the brain, cognitive damage, and heart damage. As a consequence of her permanent injuries, the woman will likely incur future medical expenses.

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