Fatal Oversight: Misdiagnosis of Nocturnal Chest Pain with Elevated D-dimer. Commentary by Vijay Agusala, MD, MBA, James Deen, MD and Saul Schaefer, MD| May 29, 2024

A man in his 70s with a past medical history of lymphoma in remission, obesity, hypertension, hyperlipidemia, obstructive sleep apnea, and supraventricular tachycardia presented to the emergency department (ED) after two weeks of nightly chest pain episodes. His primary care physician had ordered laboratory testing, which was unremarkable other than a slightly elevated D-dimer (which was normal when adjusted for age). His physical examination and laboratory tests in the ED were normal and he had a record of normal stress testing from two years prior. The patient was discharged from the ED the same day but passed away at home two days later due to severe coronary artery disease. The commentary discusses the varied presentation of unstable angina, use of appropriate evaluation and risk stratification, as well as organizational strategies to facilitate thorough patient evaluation across multiple providers, such as standardized patient handoff methods. https://psnet.ahrq.gov/webmm-case-studies