Thanks to Drs. Harrell and Bower for their excellent case discussion in the October issue of ACEP Now. They made a final diagnosis of hypertrophic obstructive cardiomyopathy and discussed how that diagnosis was made despite the initial anchoring on the wrong diagnosis. They continued to work the patient when they noted that the main presenting sign—tachycardia—persisted after the treatment for the initially anchored diagnosis, anxiety and panic disorder, and, possibly, hypovolemia.
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ACEP Now: Jan 01I have called this “disconfirming” evidence, meaning that it does not confirm the initial, anchored diagnosis. Good emergency medicine practice would be to look for these disconfirming findings prior to making the final diagnosis.
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