Clinical Presentations for Advanced Practice Clinicians: Failure to Diagnose Myocardial Infarctions


In reviewing closed malpractice claims, TDC Group 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 #: ANE 221073.0 Issue Date: 6/15/2022 Expiration Date: 6/15/2025

Description of the Professional Practice Gap (PPG)
Problems with clinical judgment can prevent APC's from making timely diagnoses. Failures may result when patient assessments are incomplete, there is a narrow diagnostic focus, or a diagnostic test is misinterpreted.  Other factors that hinder timely diagnoses include communication and failure to appreciate signs and symptoms.  Additionally, errors in judgment and cognitive bias can lead to misdiagnosis.

Learning Outcome

  •  The learner will be able to recognize cognitive biases that contribute to errors in the diagnostic process and select two   strategies to implement in their practice that can reduce the risk of a malpractice claim related to acute Myocardial  Infarction (MI).

Learning Objectives

After completing this activity, learners will be able to:

  • Demonstrate knowledge of the clinical challenges that contribute to missed or delayed diagnosis of MI in the primary care setting by correctly answering questions.
  • Correctly identify how heuristics and cognitive bias can contribute to the failure to diagnose.
  • Select appropriate strategies to overcome cognitive bias in the diagnostic process.
  • Correctly identify atypical signs and symptoms of MI experienced by women.
  • Correctly identify underlying reasons for communication failures that contribute to misdiagnosis.
  • Select two strategies to implement that can reduce the risk of a malpractice claim involving the failure to timely diagnose and treat MI.

Course Developers

Kimberly Hathaway, MSN, RN, CPHRM, CPHQ, Director Patient Safety Healthcare Quality & Risk Management, The Doctors Company
Angela Jordan, MHSc, RN, CPHRM, Patient Safety Analyst, 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

Accreditation and Disclosure Statements
The Doctors Company is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

The Doctors Company designates this activity for a maximum of 0.5 nursing contact hourLearners should claim only the credit commensurate with the extent of their participation in the activity.
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. 

Disclaimer Statement
This program is being offered for informational and educational purposes only from a Patient Safety Risk Management perspective and does not constitute legal advice. Laws vary from state to state, actual clinical situations often involve subtle differences and nuances from program scenarios or recommendations, and the recommendations provided in this activity may not apply to all practice situations. In complex circumstances, which present significant potential for an adverse event or litigation, TDC and the faculty recommend you consult directly with your corporate or personal counsel for professional legal guidance. 

Complies with State Requirements

Please SEE the Registered Nurse and Licensed Practical Nurse CE Requirements by State.

Technical Requirements

The activity is best experienced using the most current browser: Firefox, Chrome, Safari, or Microsoft Edge. Internet Explorer is not supported on this platform. All activities featuring audio must have a speaker. To view graphic images and references that appear in separate "pop-up" windows, JavaScript and session cookies must be enabled on your computer. Adobe Acrobat Reader may be required for certain activities.

Contact Us

If you have questions, contact or call 800.421.2368.


Visit our Resource document for this program.