February 2026

When Trauma Triggers Death in Patients with Pre-Existing Heart Disease

February is American Heart Month, which makes it an appropriate time to revisit a recurring issue in personal injury cases: how pre-existing heart disease is often treated as a stopping point rather than the start of a proper causation analysis.

We recently consulted on a case involving a high-impact auto collision. The client sustained severe traumatic injuries, including multiple rib fractures, leg fractures, and a partially amputated foot. He was airlifted to the hospital and died shortly after arrival in the emergency department.

The county coroner attributed the death to heart failure secondary to severe coronary artery disease, describing the automobile accident as a “possible contributory factor.” That language is common, and it is often where insurers attempt to discount the role of trauma.

From a medical standpoint, this framing is incomplete.

Severe trauma produces an intense physiologic stress response, including a surge of catecholamines (organic compounds, specifically monoamine neurotransmitters and hormones, that play a critical role in the body’s acute "fight-or-flight" stress response). In patients with advanced coronary artery disease, this response can acutely narrow already compromised vessels while increasing myocardial oxygen demand. The result can be sudden cardiac failure that would not have occurred at that time but for the traumatic event.

In this context, heart disease represents vulnerability, not inevitability. The trauma serves as the precipitating event.

This mechanism is well supported in the medical literature, which consistently shows higher mortality rates following major trauma in patients with pre-existing cardiac disease, particularly when multiple cardiac risk factors are present. These deaths are temporally and biologically linked to the traumatic injury rather than occurring independently of it.

As we summarized in our analysis:

Stating that a patient died of heart failure due to coronary artery disease on the day of a massive auto accident is like stating someone died of “lack of oxygen” without mentioning they drowned.

 The heart disease was the “water” (the vulnerability), but the auto accident was the “drowning” (the precipitating event).

When a client has underlying heart disease, the key medical question is not whether the disease existed, but whether the trauma triggered the fatal event. That distinction is easiest to establish when it is addressed early, before the medical record collapses causation into a single diagnosis.

This situation is another example of how we can assist you with all the medical issues in your cases and occasionally find previously undiagnosed medical damages. 

Let’s Talk About Your Case

Whether you need:

✅ A quick medical read

✅ A focused opinion letter

✅ Or full case strategy support

I’m happy to talk through how we can help.

 — Dr. Darshika Goswami, MD

Pacific Northwest MD Legal Consulting

📧 info@pnwmdlegal.com

📞 (503)‑308‑9186

🌐 www.pnwmdlegal.com

January 2026

Can a Treating Doctor’s Causation Opinion Be Wrong and Hurt Your Case?

This Month’s Case: When Early Input From a Physician Consultant Changes the Trajectory

We were recently asked to consult on a case that highlights a crucial question for attorneys handling injury claims:

What happens when the treating physician gets the causation wrong?

The Story:

A 49-year-old woman working retail had multiple boxes fall off a shelf, striking both legs—worse on the left. She was able to walk afterward and didn’t seek immediate care. Over the next three weeks, however, her left calf developed persistent aching, then mild swelling, and finally became painfully swollen, prompting an ER visit.

Diagnosis: acute deep vein thrombosis (DVT) in the left popliteal vein (behind the knee).

Treatment: standard anti-coagulation and follow-up care.

This is where the medical narrative diverged.

The patient had also been under the care of a gynecologist for large uterine fibroids, and during a routine visit (coincidentally the same week she was diagnosed with DVT), the gynecologist suggested her clot was caused by pelvic vein compression from the fibroids. The hematologist agreed referencing the gynecologist’s note and ruling out inherited clotting disorders.

The work injury was not mentioned.

When she applied for workers’ compensation, she pointed to the obvious timeline: trauma ➝ lingering pain ➝ swelling ➝ clot.

But now, the medical record contained two alternate opinions, neither of which accounted for the workplace trauma. That could have jeopardized the claim.

The Analysis: Medical Literature Tells a Different Story

As physician consultants, our role is not to override treating doctors but to ground causation in anatomy, mechanism, and evidence-based reasoning. Here’s what we found:

1. Anatomic Inconsistency

• Fibroids may cause DVT but only when very large, and usually in the pelvic or proximal femoral veins.

• A popliteal vein DVT (behind the knee) is anatomically inconsistent with fibroid-related compression.

Conclusion: The proposed mechanism doesn’t align with known patterns of fibroid-related DVT.

2.  Trauma Is a Well-Established Risk

• Blunt leg trauma is a strong transient risk factor for DVT, particularly when deep tissue is involved.

• Injury causes vascular endothelial damage, triggering clot formation.

Conclusion: The trauma mechanism fits the known pathophysiology of post-traumatic DVT.

3.  Timeline Consistency

• Trauma-related DVTs typically develop within 2–3 weeks, precisely what occurred here.

• The progression from calf ache ➝ swelling ➝ clot is classic.

Conclusion: The temporal pattern supports a trauma-related DVT.

4.  Fibroid-Associated DVT Is Exceptionally Rare

• These cases are so uncommon they’re often published as case reports.

• Increased incidence appears only when uterine weight exceeds 1,000g—which was not the case here.

Conclusion: Fibroid-related DVT was statistically and clinically unlikely.

The Timeline Told a Different Story

The client, however, recognized a clear sequence, leg trauma followed by persistent pain, swelling, and eventual clot formation and believed her DVT was work-related. She filed a Workers’ Compensation claim, asserting that the clot stemmed from her on-the-job injury.

Why This Matters for Attorneys

This case underscores a critical point:

Treating physicians may mean well but their causation opinions can be wrong, and that can hurt your case.

In this situation:

• The anatomic location (popliteal vein)

• The injury mechanism (blunt leg trauma)

• The timeline (3 weeks to thrombosis)

…all point toward a work-related trauma as the cause not uterine fibroids.

 Our detailed medical review, complete with literature citations gave the attorney the evidence needed to challenge the treating physician narrative and support the client’s claim.

Whether you’re navigating delayed symptoms, chronic pain, or pre-existing conditions, we bring early medical clarity, so you can build stronger cases with less cost, fewer delays, and greater confidence.

Let’s Talk About Your Case

Whether you need:

✅ A quick medical read

✅ A focused opinion letter

✅ Or full case strategy support

I’m happy to talk through how we can help.

 — Dr. Darshika Goswami, MD

Pacific Northwest MD Legal Consulting

📧 info@pnwmdlegal.com

📞 (503)‑308‑9186

🌐 www.pnwmdlegal.com

December 2025

Can Trauma Precipitate Fibromyalgia?

Pacific Northwest MD Legal Consulting Medical Perspective

When a 39-year-old woman was hit by a drunk driver on the driver’s side of her vehicle, she didn’t think the injuries were serious. She was seat-belted, the airbags didn’t deploy, and X-rays in the ER were negative. She was discharged with a diagnosis of soft tissue strain.

But weeks later, her pain hadn’t resolved. It had spread from her neck and chest to her shoulder and upper back. Physical therapy worsened her symptoms. MRI imaging was unremarkable. A bone scan later showed mild increased uptake in the clavicle and upper chest, but still no structural damage.

Eventually, she was referred to a rheumatologist, who diagnosed fibromyalgia, a chronic pain condition that appeared to be precipitated by the collision.

Her symptoms now included widespread pain, fatigue, “fibro fog,” and significant functional decline. One year post-collision, she remained symptomatic and struggled with daily activities and work.

Medical Insight: When Trauma Triggers Fibromyalgia

Fibromyalgia is not a structural injury. It’s a disorder of central pain processing, involving:

• Neurochemical imbalances (e.g., low serotonin, norepinephrine, dopamine)

• Central sensitization — where normal sensations become painful (allodynia)

• Disrupted pain inhibition — the nervous system amplifies pain signals instead of filtering them

Although its exact cause remains unclear, physical or emotional trauma can unmask or trigger fibromyalgia, especially in individuals with predisposing factors.

In this case, persistent pain following trauma, negative imaging, and evidence of localized inflammation (bone scan) aligned with early central sensitization, a known precursor to fibromyalgia.

Why This Matters in Personal Injury Cases

Fibromyalgia often presents without objective findings — but that does not mean the condition is unfounded. Understanding how trauma can initiate central pain syndromes is essential in evaluating:

• Causation

• Credibility of symptoms

• Long-term prognosis and damages

The absence of MRI or CT abnormalities doesn’t negate real impairment, especially when the timeline aligns, and other causes have been excluded.

Medical-Legal Takeaway

In personal injury and disability cases, fibromyalgia can be both real and trauma-induced.

A clear understanding of central pain mechanisms, paired with a detailed clinical timeline, helps attorneys:

• Recognize when fibromyalgia may be causally linked to an event

• Support claims in the absence of structural damage

• Articulate functional impairment in a language that holds up medically and legally

Need help reviewing a case involving fibromyalgia, chronic pain, or unclear imaging findings?

Let’s talk. Early physician input can make a critical difference.

Let Us Know How We Can Help You

• Medical Summary Reports

• Help with strategies to promote medical theories

• Interpretation of meaning, or lack thereof, of medical reports & records

• Reviews of IME Reports

• Independent Record Reviews

• Assessment of case validity regarding medical issues

• Referral to appropriate expert medical witnesses

• Medical Research

• Facilitation of communication with clients, families, professionals and service & governmental agencies

• Case Coordination

• Facilitation of communication with treating doctors

• Table-side deposition assistance or deposition question preparation

As you know, we have purposefully kept our fees exceptionally low allowing you the opportunity to have us review your cases early in your representation while controlling your expenses.

CONTACT US for information or fee schedule.

info@pnwmdlegal.com or 503-308-9186

November 2025

What Makes a Strong Medical Report?

From an Adjuster’s Perspective

Pacific Northwest MD Legal Consulting

Medical reports are a key component in understanding the full scope of an injury and its consequences. When done well, they do more than summarize records, they explain the clinical reasoning that connects findings, treatment, and functional impact. A clear, well-supported report helps adjusters and attorneys evaluate the legitimacy, value, and complexity of a claim.

Understanding the Audience

Medical reports are often reviewed by multiple parties: attorneys, claims adjusters, opposing counsel, judges, treating physicians, and independent medical examiners. Each reader brings a different lens but all are looking for the same fundamentals: clarity, accuracy, and sound reasoning.

Writing with this diverse audience in mind ensures the report supports both the medical facts and the legal strategy.

Causation and Mechanism of Injury

Most treating physicians focus on patient care not on dissecting why the injury occurred. Withing a medical-legal framework, the mechanism of injury and whether it is causally related to the event in question is essential.

When appropriate, strong reports explain how the medical findings support (or do not support) causation and how the mechanism aligns with the diagnosis and symptoms. This level of clarity can directly impact how a claim is interpreted, valued, and resolved.

Commentary on Treatment and Medical Necessity

A well-constructed report also addresses whether treatment was:

• Medically necessary

• Reasonable

• Causally related to the event

These distinctions help clarify what aspects of care are tied to the incident versus those arising from pre-existing or unrelated conditions.

Precision and Individualization

Effective reports are individualized, not templated. Generic or repetitive language weakens credibility and risks overlooking case-specific details.

The strongest reports:

• Use precise clinical language

• Reflect accurate timelines

• Apply correct diagnoses and coding

• Offer an objective summary of the case’s unique medical facts

This precision builds trust and supports defensible conclusions.

Language and Presentation Matter

Subtle shifts in language can shape the reader’s understanding.

• “Cervical spinal injury” is more specific and more persuasive — than “neck strain.”

• “Motor vehicle crash” emphasizes impact, while “accident” may imply unpredictability or lack of severity.

Well-written reports also document functional loss, describing how injuries affect the individual’s ability to work, perform daily tasks, and engage in normal activities.

Addressing Pre-existing Conditions and Multiple Incidents

Degenerative conditions like arthritis often cloud causation questions. A strong report separates baseline disease from trauma-induced changes. When multiple injuries or prior incidents are involved, apportioning symptoms clearly and credibly is critical.

This clarity helps adjusters determine what portion of the injury is truly attributable to the event in question.

Collaborative Approach

Medical-legal consulting can also bridge the gap between treating physicians and legal teams. Consultants can guide clinicians on how to document findings more effectively — ensuring the medical record reflects:

• Clear causation

• Appropriate treatment rationale

• Objective functional outcomes

This not only supports the legal case — it protects the treating provider’s role and the integrity of the record.

Takeaway:

A strong medical report is:

✔ Clear

✔ Accurate

✔ Objective

✔ Grounded in evidence-based reasoning

✔ Tailored to both medical and legal audiences

By emphasizing causation, treatment necessity, and functional outcomes, physicians can create reports that meaningfully inform the claims process — and support fair, just outcomes for clients.

Let Us Know How We Can Help You

• Medical Summary Reports

• Help with strategies to promote medical theories

• Interpretation of meaning, or lack thereof, of medical reports & records

• Reviews of IME Reports

• Independent Record Reviews

• Assessment of case validity regarding medical issues

• Referral to appropriate expert medical witnesses

• Medical Research

• Facilitation of communication with clients, families, professionals and service & governmental agencies

• Case Coordination

• Facilitation of communication with treating doctors

• Table-side deposition assistance or deposition question preparation

As you know, we have purposefully kept our fees exceptionally low allowing you the opportunity to have us review your cases early in your representation while controlling your expenses.

CONTACT US for information or fee schedule.

info@pnwmdlegal.com or 503-308-9186

P.S. ---Please pass this Newsletter along to your colleagues if you found it helpful.