This case involves a 10-year-old female patient that presented to her family doctors office with nonspecific chest pain. According to reports from the parents, the doctor performed a very brief physical exam and diagnosed the patient with a viral upper respiratory tract infection with associated chest irritation. The patient was sent home without any medications or desire by the physician for further workup. Within a few hours of returning home, the patient experienced a syncopal episode and  was transported via ambulance to a Major New York Hospital. At the time of her presentation to the Emergency Department at 14:21 the patient was lethargic, complained of chest pain,  her blood pressure was 65/45 and heart rate was 184. The patient was triaged at 14:24 and despite these alarming symptoms, the patient and family were instructed by the triage nurse to take a seat in the waiting room. The attending emergency room physician at the time of the incident had a shift that ended at 15:00.  This doctor left the emergency department at the end of his shift without seeing the critically ill patient. The next ER doctors shift commenced at 15:00. The patient had been in the waiting area for thirty-nine minutes and was not taken back to an examination room until 15:30.  At this point, the patient had a documented decreased level of consciousness along with diffuse abdominal tenderness, a heart rate of 170-180 and a thready pulse.  Cardiac monitoring revealed wide complex ventricular tachycardia. Blood gas studies revealed a pH 7.22, pC0 49, BE 7.8 and elevated cardiac enzymes. Patient experienced seizure activity at 16:08 followed by cardiac arrest. CPR was initiated and the patient was intubated but efforts were futile as the time of death was reported at 16:50. Upon autopsy cause of death was determined to be lymphocytic myocarditis.
