In Interventional Cardiology Expert Witnesses: Essentials for Attorneys, Dr. Burton Bentley writes that “given the widespread prevalence of heart disease in the US population, issues related to cardiology occur in countless medical negligence cases. Consequently, in the realm of medical expert witnesses, the Interventional Cardiology expert witness is King.”
Interventional Cardiology is a subspecialty of cardiology relying upon highly specialized cardiac procedures to diagnose and treat coronary artery disease. Cardiologists who employ these techniques to intervene in the course of coronary artery disease are known as Interventional Cardiologists. Since Interventional Cardiologists have expertise in both the diagnosis and interventional treatment of cardiac disease, issues addressed by Interventional Cardiology expert witnesses may focus on standard of care, breach, and/or harm. Interventional Cardiology experts also opine upon standard practices involving billing, compliance, resource utilization, and observation v. admission status.
Standards of care relate to the principles, practice, and procedures of Interventional Cardiology. The most frequent Interventional Cardiology procedure is angioplasty, also known as Percutaneous Coronary Intervention, or PCI. During PCI, an Interventional Cardiologist inserts a catheter into an artery and then threads the catheter to the level of the heart. The target artery is one or more coronary arteries perfusing the heart. The Interventional Cardiologist monitors the location of the catheter by injecting dye and viewing real-time images during the procedure. When a coronary artery is determined to have significant narrowing due to atherosclerosis (plaque), the Interventional Cardiologist will perform an “angioplasty”, literally reshaping the interior of the blood vessel. The angioplasty catheter uses a tiny balloon to press plaque against the luminal walls of the artery, effectively opening the internal diameter and improving blood flow. In 70% of angioplasty procedures, the Interventional Cardiologist will also deploy a stent. Stents are tiny metal tubes that remain in place to permanently reinforce the artery wall.
The same PCI techniques of vascular entry and guidewire insertion form the foundation for nearly all Interventional Cardiology procedures. Other procedures include:
Atherectomy: The use of tiny devices such as burrs or lasers to physically remove plaque from coronary arteries.
Balloon Valvuloplasty: The use of balloon catheters to physically open narrow heart valves (e.g. aortic stenosis).
Percutaneous Valve Repair: The use of specially equipped catheters to repair abnormal heart valves.
Transcatheter Aortic Valve Replacement (TAVR): TAVR is a revolutionary non-surgical treatment for aortic stenosis. During TAVR, the Interventional Cardiologist deploys a prosthetic aortic valve that is instantly deployed over the patient’s native valve. The native valve is entirely displaced while the new valve functions in its place.
The most common standard of care allegations include procedural delays, particularly during the treatment of acute myocardial infarction. Other allegations may involve procedural complications such as hemorrhage (e.g. hematoma or retroperitoneal hemorrhage), vessel rupture, nerve injury, device malfunction, embolism, and stroke. Given the complexity of interventional cardiology procedures, only a Board-Certified, full-time practicing Interventional Cardiology expert witness can opine upon the applicable standard of care.
In additional to opining on standard of care, an Interventional Cardiology expert witness is often required to address causation. Causation arguments may arise when an Interventional Cardiologist is alleged to have acted negligently. In other words, did the alleged malpractice result in harm? Interventional Cardiology experts also evaluate causation when a patient suffers a deprivation of care by not being referred to an Interventional Cardiologist in a timely manner. For example, allegations may arise when a primary care provider fails to refer a patient with chest pain, or when an Emergency Medicine specialist delays admission to the cardiac catheterization lab. Such situations mandate meticulous analysis, and only a credible and independent Interventional Cardiology expert witness can connect the dots.
Since Interventional Cardiology experts are also Cardiologists, IC experts are also called upon to determine the existence, nature, extent, and prognosis of cardiac harm. For example, when a patient suffers a myocardial infarction (i.e. heart attack), what is the extent of the injury and how will it impact the patient’s health? Investigating the status and degree of cardiac harm is an essential strategic element is many cases. Once again, a skilled and impartial Interventional Cardiology expert witness will be the key to your case’s success.
In countless areas of medical litigation, from billing and compliance to percutaneous coronary angioplasty, the Interventional Cardiology expert witness plays a pivotal and irreplaceable role. To succeed in your next cardiac case, take the time to properly understand and utilize the knowledge of this mission-critical expert.
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