Weighing Genetic Factors in Cardiovascular Cases

Cardiovascular cases involving occupational risks are complicated causation proof issues in workers' compensation cases. The association of the work exposure and/or effort is usually a challenging proof battle where literature and medical experts are caught in a contentious duel.

NJ Court Sets the Evidentiary Proof Standard for a Pulmonary - Cardiovascular Claim

A NJ Workers' Compensation Court affirmed the dismissal of a pulmonary claim ruling that the evidence presented was lacking, and that the statutory limitations of expert medical fees do not act to the detriment of the injured worker in the proof of a workers' compensation claim.

"In her written opinion, the compensation judge found the testimony of Dr.Kritzberg more credible than that of Dr. Hermele. The judge found that petitioner's counsel “trie[d] to make it appear that petitioner presented to Dr. Hermele on his own for treatment. That is simply not true. Petitioner's counsel sent petitioner to Dr. Hermele. Dr. Hermele did not treat petitioner.” Additionally, of great significance to the compensation judge was the fact that petitioner had been treating with a cardiologist for twenty-three years, testified that he believed his breathing difficulties were related to his heart condition, and had never been treated for any pulmonary condition, despite testifying that his pulmonary complaints worsened in 1988, while continuing to work for respondent for eleven more years. The judge inferred that petitioner's cardiologist never referred him to a pulmonary specialist for treatment.

The Court also held that an "adverse inference" could be drawn when the injured worker does not offer supporting medical records into evidence to prove a claim.

"The compensation judge drew an adverse inference “from the fact the petitionernever produced a certified copy of the records from his treating cardiologist orhad Dr. Hermele review said records as part of his evaluation[,]” noting that Dr.Hermele readily admitted “there is a relationship between the heart and thelungs.”

Furthermore, the medical evidence presented at the time of trial, support the lack of causal relationship of a pulmonary medical condition caused by a pre-existing cardiovascular condition, rather than an independent pulmonary condition cause by exposure to industrial air pollution.

"Critical for the court were the chest x-rays taken of the petitioner which
showed that he did not have bi-lateral flattening of his diaphragm. If he
truly had pulmonary disease unrelated to his heart condition[,] you would expect
to find bi-lateral flattening of the diaphragm. Only the left side of petitioner's diaphragm was flattened[,] which is to be expected since both doctors
agreed petitioner has cardiomegaly (enlargement of the heart).....

FDA Warns Zithromax® / Zmax® Antibiotics Potential Risk of Fatal Heart Rhythms

The U.S. Food and Drug Administration (FDA) is warning the public that azithromycin (Zithromax or Zmax) can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm. Patients at particular risk for developing this condition include those with known risk factors such as existing QT interval prolongation, low blood levels of potassium or magnesium, a slower than normal heart rate, or use of certain drugs used to treat abnormal heart rhythms, or arrhythmias. 

This communication is a result of the FDA's review of a study by medical researchers as well as another study by a manufacturer of the drug that assessed the potential for azithromycin to cause abnormal changes in the electrical activity of the heart.

The azithromycin drug labels have been updated to strengthen the Warnings and Precautions section with information related to the risk of QT interval prolongation and torsades de pointes, a specific, rare heart rhythm abnormality. Information has also been added regarding the results of a clinical QT study which showed that azithromycin can prolong the QTc interval. (see Data Summary)

Health care professionals should consider the risk of fatal heart rhythms with azithromycin when considering treatment options for patients who are already at risk for cardiovascular events (see Additional Information for Health Care Professionals below).  FDA notes that the potential risk of QT prolongation with azithromycin should be placed in appropriate context when choosing an antibacterial drug: Alternative drugs in the macrolide class, or non-macrolides such as the fluoroquinolones, also have the potential for QT prolongation or other significant side effects that should be considered when choosing an antibacterial drug.