Baylor pathologist says no heart attack in Vioxx case

Baylor pathologist says no heart attack in Vioxx case

08/09/2005

By KRISTEN HAYS / Associated Press


An emergency room doctor who blamed a heart attack for a Texas man's death made a "best guess" that an autopsy later ruled out, the head of Baylor College of Medicine's pathology department testified Tuesday in the nation's first Vioxx-related civil trial.

Dr. Thomas Wheeler conceded that the doctor on duty at the ER where Robert Ernst, 59, was taken the night he died noted common heart attack symptoms of chest discomfort and shortness of breath. But Wheeler said an autopsy accurately attributed his death to arrhythmia, or an irregular heartbeat, secondary to clogged arteries.

The ER doctor "made a best guess, and the pathologist solved the problem in the autopsy," said Wheeler, a witness for Vioxx maker Merck & Co.

Whether a heart attack or arrhythmia alone caused Ernst's death is central to the first of more than 4,200 state and federal Vioxx-related lawsuits to go before a jury.

The New Jersey pharmaceutical company pulled Vioxx from the market nearly a year ago when a study showed it could double risk of heart attack or stroke if taken for 18 months or longer. But Merck says no studies link Vioxx to arrhythmia, so the drug couldn't have caused Ernst's death.

Ernst's widow, Carol, alleges the once-popular painkiller caused a blood clot that led to a heart attack, but he died too quickly for his heart to show damage. The coroner who performed his autopsy corroborated their view last week.

Wheeler said he agreed with the coroner's original conclusion, noting she did "an excellent job examining coronary arteries" that were blocked by up to 75 percent.

But he said he disagreed that the arrhythmia was likely triggered by a heart attack. Wheeler said there was no evidence of a heart attack or a blood clot that may have caused it.

Carol Ernst's lawyer, Mark Lanier, challenged Wheeler's contention that Ernst's clogged arteries led to his death. Ernst, a produce manager at a Wal-Mart who ran marathons and taught aerobics classes, died in his sleep.

Lanier presented passages in a medical textbook that said patients would need to have at least 90 percent blockage in coronary arteries to die while at rest from lack of blood to the heart. Wheeler disagreed.

Yet Wheeler acknowledged that Ernst's blood flow sustained him during strenuous exercise, including the day he died.