The Claimant had a family history of cardiac events. He was referred for a chest x-ray by his GP, which identified patchy consolidation and liquid in the lung.

Thereafter the Claimant was further referred by his GP to hospital following a two week history of persistent vomiting and abdominal pain. The referral queried cholecystitis or pancreatitis, however there was no mention of a family history of heart problems. A surgical registrar took a history of sudden onset 4 days of nausea and sickness followed by right flank/back pain and it was noted that the Claimant was generally unwell and tired, as his cough interfered with sleep. On examination there was mild upper right quadrant tenderness. The registrar did not have a clear impression of what the underlying problem might be but queried gastritis, biliary, renal and/or pleuritic issues. The Clamant was discharged overnight, to be reviewed the next day.

Ultrasound scanning disclosed gallstones and a plan was made to continue antibiotics, and return for a gastroscopy and possibly biopsies.

The Claimant’s condition deteriorated further, and he visited the GP again complaining of chest pain and swollen legs but the Claimant remained in considerable pain despite medication have been prescribed.

A gastroscopy was carried out but the plan was to continue with medication. The Claimant was reassured in a telephone call that the problem was one of gastritis.

The Claimant, still feeling generally unwell with right upper quadrant pain and vomiting, was admitted to hospital where a decision was made to remove his gallbladder.

It was noted that there had been an episode of shortness of breath the previous week and the Claimant complained of feeling exhausted but still no family history was considered.

In the course of the operation the Claimant’s blood pressure briefly reduced but was successfully brought back up. There were two other short episodes of hypotension, successfully managed. However, there was a gradual desaturation to about 90%.

The duty anaesthetist was called. Deterioration continued, but the reasons for this were not clear at the time. Pulse was lost, resulting in a cardiac arrest. Various diagnoses were considered, and a request made for a mini-laparotomy to exclude the possibility of bleeding from the operative site.

After 10-15 minutes frank pulmonary oedema started via the endotracheal tube. An x-ray demonstrated cardiomegaly and a formal arrest call was put out and the Claimant required advanced CPR and Adrenaline.

The Claimant’s family were informed of the situation, and gave a history of the Claimant’s father dying of a cardiac condition in his early 40’s.

An intra-aortic balloon pump was inserted and advice was taken from Harefield Hospital and St Thomas’s Hospital.

A biventrical assist device was implanted and the Claimant required further surgery the following day due to a large clot in the right atrium and a large collection around the left ventricle.

The Claimant sustained a large ischaemic left middle cerebral artery stroke, confirmed by CT scan the following day, which initially caused right sided weakness and speech problems. Speech and Language therapy was provided but the Claimant continued to have problems with reading and advanced comprehension and it remains the case that he has difficulty finding some words. The fatigue and post -stroke fatigue were said to be permanent.

Ultimately, the Claimant was required to undergo a heart transplant.

The Trust admitted that the Chest X-Ray should have been considered by the Treating Team before surgery was performed and further that the ECG recorded abnormalities but no further action was taken in this regard.

The Trust further acknowledged that given the abnormal chest x-ray and ECG, both of which suggested underlying heart muscle disease, the operation should have been delayed and a cardiac opinion should have been sought.

It was however agreed that even if cardiac opinion had been obtained and the operation delayed, the Claimant would still have had a reduced life expectancy due to the underlying cardiomyopathy. It was also agreed that given his family history, that he would have required a heart transplant at some point in the future.

The claim settled prior to the issue of proceedings at a Joint Settlement Meeting in the sum of £320,000.