Steve presented to his primary care team in early November complaining of symptoms that could be heart-related, so he was referred to a cardiologist. He told the cardiologist he had episodes of exertional chest pain as well as pain that would wake him at night. The cardiologist thought his symptoms were caused by previously diagnosed heartburn and recommended he double his dose of heartburn medication.

Eleven days later, just before Thanksgiving, the cardiologist’s office called Steve, who told them he was continuing to have chest pain off and on. Four days later the cardiologist recommended Steve come in for a stress heart test in December. That same day Steve suffered a heart attack.

Mike visited his primary care physician complaining of chest pain upon exertion, and an EKG in the office was read as abnormal. The primary care doctor sent him to the local hospital’s emergency room, which admitted him to rule out a heart condition as the cause of his symptoms.

Unfortunately, the admitting doctor never asked him about the nature of his symptoms, specifically whether he had exertional pain, a classic symptom of Acute Coronary Syndrome. Had the doctor asked, he would have ordered a formal cardiology consult, leading to angiography, discovery of the arterial occlusion causing the symptoms, and either stenting or bypass surgery. Unfortunately none of this was done, a “normal” pharmacological stress test was misleadingly reassuring, and he was discharged. He died of a heart attack four days later.