Heart attacks and “the 90-minute rule”

Heart attack, even suspected, is a true emergency.[1] Any medical provider presented with possible heart attack must give it the highest priority. Failure to do so may be the basis for suit against those responsible for delay in evaluation or treatment.

Today, standards in treating heart attack are largely based on the ability of cardiologist specialists to perform “catheterizations” to open blocked vessels, through lines passed into the blood vessels of the groin area or arm. Such “cardiac catheterization” has greatly increased survival and lessened heart damage in recent years. Most major hospitals have a “Cardiac Catheterization Team” (“Cath Team”) that is supposed to be mobilized once diagnosis of a blocked heart vessel appears a substantial possibility from early tests such as EKG.[2]

Most major hospitals have some form of Cath Team. If not, immediate transfer to a Cath Team-capable hospital is generally considered the standard if heart vessel blockage is strongly suspected.

The American Heart Association has written guidelines for the sequence of care doctors should follow for suspected heart attack. [3] Deviation from the guidelines may be evidence of malpractice (typically arises in the ER setting):

  • Within 10 minutes of arrival: An EKG should be applied
  • Within 30 minutes of arrival: diagnosis of heart attack should be made.
  • In next 30 minutes (within an hour of arrival): Cardiac Catheterization team should be involved.
  • In next 30 minutes (within 90 minutes of arrival): The blocked vessel should be opened by catheterization, if suitable to that form of treatment.

The sum of these standards is often called the “90 minute, door-to-balloon” rule. The “balloon” refers to the catheterization tool that actually opens arteries, which expands (like a balloon) to open the clogged portion of the artery.

This means that when everyone is doing their job properly, for a heart attack that can be treated by “balloon” (catheterization) that treatment should generally be given within 90 minutes of the patient’s arrival to an ER.

We have successfully represented patients improperly treated during heart attacks. Often, the starting point is to evaluate whether care lives up to the “guidelines” of how care should be given.

If you believe your care was improper, we can evaluate your records and advise you on your legal options.

[1] A heart attack is referred-to medically as “myocardial infarction.”
[2] EKG or “ECG” is a non-invasive test in which electrical leads are taped to the chest. It can be given in a few minutes and generates results almost immediately once applied. EKG is one of the primary and very accurate means by which physicians can detect heart attacks and other types of abnormal heart activity.
[3] American Heart Association/American College of Cardiology (“AHA/ACC”) Clinical Performance and Quality Measures for Adults With ST-Elevation and Non-ST Elevation Myocardial Infarction (2017); ACC/AHA Focused Update on Primary Percutaneous Coronary Intervention for Patients with ST-Elevation Myocardial Infarction (2015); AHA/ACC Guideline for the Management of Patients With Non-ST Elevation Acute Coronary Syndromes (2014).