Deceased
Errol Leslie Solly
Demographics
67y, male
Coroner
Coroner Audrey Jamieson
Date of death
2021-06-15
Finding date
2024-05-06
Cause of death
Ischaemic heart disease; coronary artery atherosclerosis (stented)
AI-generated summary
A 67-year-old man with extensive cardiac history presented to the ED with recurrent ischaemic-sounding chest pain. Despite multiple episodes of chest pain during admission, initial ECGs and troponins were normal. Following a telephone consultation with cardiology, he was discharged with a plan for outpatient investigations. He suffered a fatal inferior STEMI later that evening. The coroner found that further serial troponin testing should have been performed per the Assessment Protocol for patients with recurrent ischaemic chest pain, representing a missed opportunity to alter his clinical course. The case highlights the importance of adhering to risk stratification guidelines, particularly in settings without on-site cardiology specialists, and proper escalation procedures.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Error types
Drugs involved
Clinical conditions
Procedures
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