Clinical Presentations Cause Delays: Failure to Diagnose Myocardial Infarction (Claims Corner CME)


In reviewing closed malpractice claims, The Doctors Company identified missed or delayed diagnosis of myocardial infarction (MI) in the ambulatory internal medicine setting as a reoccurring problem. This course highlights the importance of recognizing the varying clinical presentations of MI and contributing factors associated with failure to diagnose and treat. Assumptions, lack of a thorough history and physical, communication failures, and failure to recognizing atypical signs and symptoms are highlighted in this case study.

Course ID #: TDE 211002.0 Issue Date: 11/09/2021 Expiration Date: 11/09/2024


After completing this activity, learners will be able to:

  • Evaluate the clinical challenges that often cause delayed diagnosis of MI in the outpatient Internal Medicine (IM)  setting.
  • Reflect on how heuristics and cognitive bias can contribute to the failure to diagnose and implement strategies to overcome cognitive bias in the diagnostic process.
  • Identify atypical signs of MI experienced by women.
  • Develop methods aimed at recognizing a cardiac etiology and accurate interpretation of ECGs.
  • Explore underlying reasons for communication failures that contribute to misdiagnosis and address barriers by implementing communication strategies.
  • Determine which cardiac related-patient presentations require immediate referral to the emergency department.
  • Implement two strategies that can reduce the risk of a malpractice claim involving the failure to timely diagnose and treat MI.


No individual in a position to control or influence the content of this activity has reported relevant financial relationships with commercial interests. No commercial support was provided for this activity.


The information and guidelines contained in this activity are generalized and may not apply to all practice situations. We recommend that legal advice be obtained from a qualified attorney for specific application to your practice. The information is intended for educational purposes and should be used as a reference guide only.

Course Developers

Angela Jordan, MHSc, RN, CPHRM, Patient Safety Analyst, Department of Patient Safety and Risk Management, The Doctors Company

Susan Shepard, MSN, MA, RN, CPHRM, Senior Director, Patient Safety and Risk Management Education, Department of Patient Safety and Risk Management, The Doctors Company

Johanna Lackner, MPH, MSW, Senior Director, Continuing Professional Development, Department of Patient Safety and Risk Management, The Doctors Company

Continuing Education Credit

The Doctors Company is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical educational activities for physicians.

The Doctors Company designates this activity for a maximum of 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Complies with State Requirements

Please SEE the Federation of State Medical Boards overview of Continuing Medical Education requirements by State

Technical Requirements

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Contact Us

If you have questions, contact or call 800.421.2368.


Visit our Resource document for this program.