On November 5, 2012, Mr. McMullan initially visited a walk-in clinic feeling unwell. He was diagnosed with high blood pressure and an irregular heartbeat. He was sent to the emergency department at the Leamington Hospital where Dr. Sarfraz prescribed metoprolol and referred him to Dr. Naom for a consultation.
Mr. McMullan underwent an echocardiogram test on November 28, 2012. The test indicated mild aortic root dilation. Dr. Naom provided a detailed interpretation of the test results, which included atrial fibrillation, tricuspid regurgitation, elevated right ventricular systolic pressure, and mild concentric left ventricular hypertrophy.
Dr. Naom consulted with Mr. McMullan again on December 13, 2012. Despite the test results, Mr. McMullan reported no symptoms such as chest pain, shortness of breath, or palpitations. Due to a skin rash, Dr. Naom switched Mr. McMullan’s prescription from ramipril to losartan and explained that the aortic dilation was not clinically significant.
During a follow-up consultation on January 24, 2013, Dr. Naom noted that Mr. McMullan was only taking metoprolol once a day instead of the prescribed twice a day and stressed the importance of adhering to the medication routine.
On February 25, 2013, Mr. McMullan’s blood pressure and heart rate were within the target range, and he reported feeling well.
In his final consultation on May 28, 2013, Mr. McMullan was stable, with well-controlled blood pressure and no health complaints. Dr. Naom sent a sign-off letter to Dr. Blanchard and handed over Mr. McMullan’s care back to his family physician.
Years later, on February 29, 2016, Mr. McMullan attended the emergency department at Leamington Hospital and saw Dr. El Jaoudi. He had high blood pressure and symptoms of chest pain. An initial assessment was performed at 2350h, and tests including a complete blood count, glucose test, electrocardiogram, and chest x-ray were ordered. All test results were found to be normal, effectively ruling out acute pathology and end organ damage. Dr. El Jaoudi proceeded to prescribe labetalol to manage Mr. McMullan’s high blood pressure. At 0200h, a reassessment revealed that the patient’s blood pressure was well controlled. Ultimately, Dr. El Jaoudi made the clinical decision to discharge Mr. McMullan on the condition he follow up with his family physician within one week.
Unfortunately, on May 3, 2016, Mr. McMullan suffered a 1.5 cm tear in his aorta which caused his sudden and unexpected death. Mr. McMullan was 56 years old.