Sent Home With Chest Pain: When a Missed Heart Attack Raises a Malpractice Question

A patient can leave an emergency room with a reassuring discharge and still be having a heart attack. The Centers for Disease Control and Prevention (CDC) reports that a heart attack happens in the United States every 40 seconds, and it advises anyone with chest pain, shortness of breath, or other warning signs to call 9-1-1 immediately. This guide addresses a different situation: a patient receives an evaluation, goes home, and later discovers that the pain resulted from a heart attack or another serious heart condition that doctors missed.

That raises two questions. The medical one: what should have happened before discharge? The legal one: does the gap between what happened and what should have happened amount to medical malpractice under New York law?

Key Takeaways:

• A discharge from the emergency room is not, by itself, malpractice. The legal question is whether the care departed from accepted standards and whether that departure caused additional harm.
• A 2000 study in the New England Journal of Medicine found, in data from the 1990s, that about 2% of patients who had a heart attack were mistakenly sent home from the emergency department.
• One normal result does not settle the question: reference sources describe repeat electrocardiograms (EKGs) and repeat blood tests (troponin) as part of the workup when a heart attack is suspected.
• New York law gives patients a right to their hospital records, and the chart usually holds the timeline that decides whether a claim exists.
• Private-hospital claims generally must be filed within two years and six months (two years from the death in a wrongful-death case), but a claim against a public hospital can require a Notice of Claim within 90 days.

What Should Happen Before a Chest Pain Patient Goes Home

Emergency physicians evaluating chest pain look for several dangerous causes. One is acute coronary syndrome, the group of conditions that includes heart attack and unstable angina. The Merck Manual Professional Edition puts the electrocardiogram (EKG or ECG) first: it should be done as soon as possible, for example within 10 minutes of presentation. Its diagnostic approach pairs initial and serial ECGs with serial cardiac biomarker measurements, and it notes that a normal ECG taken while a patient is free of pain does not exclude unstable angina.

Doctors usually test for troponin, a protein that the heart muscle releases when damage occurs. MedlinePlus, the National Library of Medicine’s consumer health service, explains that doctors will probably retest a patient whose first troponin result is normal within the next 12 hours. Troponin levels can continue to rise for about 24 hours after a heart attack begins.That timing matters. A blood sample drawn early may look normal even when damage is underway, which is why a single early result and a prompt discharge can be a point of concern in a later review.

How Heart Attacks Get Missed in the Emergency Room

In a study published in the New England Journal of Medicine in 2000, Pope and colleagues followed 10,689 patients with chest pain or other symptoms suggesting acute cardiac ischemia at ten U.S. hospitals. Doctors mistakenly discharged about 2% of patients with an acute heart attack and about 2% of those with unstable angina. These patients were more likely to be women under 55, nonwhite, to report shortness of breath as their main complaint, or to have a normal or nondiagnostic EKG. The authors concluded that discharge was associated with increased mortality, although the difference did not reach statistical significance.The data are from the 1990s, so they show how misses happen, not how often they occur today.

Atypical symptoms are part of the explanation. The CDC lists chest pain or discomfort, pain in the jaw, neck, back, arms, or shoulders, shortness of breath, and feeling weak, light-headed, or faint. It adds that unusual or unexplained tiredness and nausea or vomiting can also signal a heart attack and that women are more likely to have these other symptoms.

A 2024 analysis in BMJ Quality & Safety by David Newman-Toker and colleagues estimated that about 795,000 Americans a year die or are permanently disabled because dangerous diseases are misdiagnosed, using modeling across major vascular events, infections, and cancers. The model also estimated heart attacks separately, at a diagnostic error rate of about 1.5% and roughly 10,000 serious harms a year, a smaller share than stroke or sepsis.

When a Missed Heart Attack Becomes a Legal Question

New York’s pattern jury instruction on medical malpractice (PJI 2:150) describes malpractice as a departure from accepted standards of medical practice. A departure alone is not enough. The departure must also have caused injury: for example, additional heart muscle damage that earlier treatment would likely have prevented or limited, or a death that timely care would likely have avoided. A thin work-up that caused no added harm generally does not support a malpractice claim.

When did the patient arrive? When was the first EKG done, and who read it? Was a troponin drawn, and was it repeated? What did the discharge paperwork say about the diagnosis and the warning signs to watch for? A heart attack misdiagnosis lawyer in New York will usually start with those answers, because the chart and the timeline decide whether a physician reviewer can support a claim.

Steps to Take After Being Sent Home

These steps preserve information; they do not replace medical care. Anyone with ongoing symptoms should call 9-1-1 or seek care first.

• Get follow-up medical care. A treating cardiologist or primary care physician can confirm the diagnosis and the current condition. Those records also document the injury.
• Write down the timeline while memory is fresh. Record arrival time, symptoms described to staff, tests performed, who spoke with the patient, and what discharge instructions were given.
• Request the complete emergency room chart. Ask for triage notes, nursing notes, physician notes, EKG tracings with their time stamps, lab results with collection and result times, and the discharge instructions.

On records, New York Public Health Law § 18 gives patients, as the subjects of the information, a right of access. A provider must make patient information available for inspection within ten days of a request and must furnish copies within a reasonable time. The statute limits charges to the provider’s costs, and caps paper copies at 75 cents per page.

New York’s Statute of Limitations and Other Deadlines

As of 2026, New York’s deadlines start running early. For care at a private hospital, Civil Practice Law and Rules (CPLR) § 214-a requires plaintiffs to commence a malpractice action within two years and six months of the act, omission, or failure they are challenging, or within two years and six months of the last treatment if the provider continuously treated the same illness, injury, or condition.The statute’s later-discovery extension in subdivision (b) applies to a failure to diagnose cancer or a malignant tumor, not to a missed heart attack.

A different track applies when the hospital is a public one, such as a facility operated by NYC Health + Hospitals. Under General Municipal Law § 50-e, a Notice of Claim generally must be served within 90 days after the claim arises. A court may allow late notice in some circumstances, but not beyond the time to start the lawsuit. Under General Municipal Law § 50-i, the action itself must be commenced within one year and 90 days after the event, except that wrongful-death actions must be commenced within two years after the death. In a death case, the 90-day notice period runs from the appointment of the estate’s representative.

New York also requires a certificate of merit. Under CPLR § 3012-a, the plaintiff’s attorney must submit a certificate with the complaint in a medical malpractice action, confirming that the attorney consulted a physician about the case. Attorneys therefore ordinarily arrange a physician review before filing the complaint, subject to limited exceptions.

What a Review of a Missed Heart Attack Looks Like at Deutsch Law

The review starts with the chart. We obtain the emergency room record, plus the ambulance record where there is one, and set it against the clock: arrival, first EKG, troponin draw, any repeat testing, and discharge. Cardiologists and emergency medicine physicians review whether the work-up met accepted standards and whether any departure changed the outcome. When the injury is serious enough to require projections of future care, we retain life care planners.

Our offices are in Midtown Manhattan and in Scarsdale, in Westchester County. Contact Deutsch Law, PC for a free consultation; the conversation starts with the timeline rather than with a promise about the result.

Frequently Asked Questions

Is being sent home from the emergency room with chest pain automatically malpractice?

No. Many patients with chest pain are appropriately discharged after an evaluation finds no sign of a heart attack. The legal question is whether the evaluation departed from accepted standards and whether that departure caused additional injury or death.

What tests are typically done before a chest pain patient is discharged?

According to the Merck Manual, the diagnostic approach for suspected acute coronary syndrome centers on an early EKG, repeat EKGs, and serial cardiac biomarker measurements. The specific work-up depends on the patient, which is why a physician reviewer looks at the whole chart.

How do I get my emergency room records in New York?

Submit a written request to the hospital’s medical records department. Under Public Health Law § 18, the hospital must allow inspection within ten days and provide copies within a reasonable time, at a charge not exceeding its costs.

How long do I have to bring a missed heart attack claim?

For a private hospital, the general period is two years and six months under CPLR § 214-a, measured from the act or omission or from the last treatment where there is continuous treatment. Claims against public hospitals follow a shorter track that begins with a 90-day Notice of Claim, so confirm the type of hospital early.

What if the missed heart attack was fatal?

Wrongful-death claims follow separate timing rules, and representatives bring them on behalf of the estate. For a private hospital, Estates, Powers and Trusts Law (EPTL) § 5-4.1 requires the estate to commence the action within two years after the death, which differs from the two years and six months allowed in a non-fatal case. For a public hospital, General Municipal Law § 50-i sets two years after the death, and the 90-day notice period runs from the appointment of the estate’s representative.

ATTORNEY ADVERTISING. This guide is for informational purposes only, is not legal or medical advice, and does not create an attorney-client relationship. Medical questions should be directed to a qualified healthcare professional. Prior results do not guarantee a similar outcome.