13. Dr D says the Trust should have admitted him for treatment on 2 November. He says as he was sent home he was concerned his condition was deteriorating and he had to seek private treatment as he did not know how long he would have to wait for a pacemaker via the NHS.
14. Dr D’s medical records show that when he attended the emergency department he presented with worsening shortness of breath. It notes he had seen a cardiologist previously and was waiting for a pacemaker due to issues with his heart rate and rhythm. The heart rate recorded at triage was 45 beats per minute (bpm).
15. NICE symptomatic bradycardia (a slow heart rate) guidance says symptomatic bradycardia is when the heart beats at a slower rate than normal and can cause faints, falls, dizziness, confusion, palpitations (when the person is aware of the heartbeat), difficulty breathing and chest pain.
16. Dr D presented with dizziness, shortness of breath and struggling to walk. His heart rate of 45 bpm suggested symptomatic bradycardia as it is usually accepted that below 60 or 50 bpm signifies bradycardia. Our ED adviser said symptomatic bradycardia is usually better managed as an inpatient and would benefit from specialist medical review by a cardiologist.
17. Before discharge from the ED the Trust did not request input from a cardiologist on the next steps of his treatment. We considered whether that step would have made any difference to the outcome for Dr D.
18. Although Dr D was experiencing a shortness of breath, there were no test results to indicate that the Trust should have admitted him. Our cardiology adviser said that, had the Trust sought cardiology input, the next steps would have been to arrange an appointment within two weeks for an echocardiogram (a scan used to look at the heart and nearby blood vessels). This is in line with the NHS guidelines on pacemaker implantation.
19. Our cardiology adviser said the Trust would also have needed to arrange to carry out a Holter monitor test, but Dr D opted to have this specific test done privately as part of his private treatment. A Holter monitor is a small, wearable device that records the heart's rhythm, usually for one to two days. It is used to spot irregular heartbeats, also called arrhythmias. A Holter monitor test may be done if a traditional electrocardiogram (ECG or EKG) does not provide enough details about the heart's condition.
20. The Trust ordered a NTproBNP blood test for Dr D. This is to test for specific levels of a chemical released in response to changes in pressure in the heart. High levels indicate heart failure.
21. This specific blood test result returned approximately half-an-hour after the Trust had discharged Dr D. However, our cardiology adviser explained this test result has no relation to a person needing a pacemaker and would not determine the urgency of fitting one.
22. Although the ED did not contact the cardiology department, we cannot say that this would have changed anything for Dr D. There was no need to admit Dr D and the course of treatment that had been arranged by the Trust would have been the same. That is, it would have discharged him. We will therefore not consider the complaint further.