A “cheeky and happy” four-year-old boy died of a rare underlying heart disease three hours after a GP sent him home, according to an investigation.
George Thomas Spencer, who had a history of contracting the viral infection group, died on March 19 last year after staff at St James’ EC Primary School in Clitheroe, Lancashire, noticed that his breathing was “fast.”
When his mother Danielle picked up George at the extracurricular club, he realized that he was having difficulty breathing, so his father Terry took him to the GP.
The four-year-old was seen by Dr. Jill Osgood at Clitheroe Health Center on March 19.
In an investigation at Accrington Town Hall yesterday, Dr Osgood said he had experience with patients with croup that could be “variable in their presentation”.
However, after assessing George, Dr. Osgood said she found that her heart rate, temperature, and oxygen saturation were “within normal parameters.”
Four-year-old George Spencer (pictured left with twin brother Arthur on the right) died of a rare underlying heart disease within three hours of being sent home by a GP , according to research.
Dr. Osgood said, “He was very talkative and joking, he spoke in full sentences, there was no hoarse voice, but I heard a loud breath.”
George, who has an identical twin brother named Arthur, was taken home, but later that night his parents noticed a deterioration in his condition.
Around 7:15 p.m., they noticed that his lips were blue and called an ambulance.
His neighbor, a qualified lifeguard who had trained paramedics in the use of defibrillators, got a machine nearby that emitted a commotion in George’s heart.
Paramedics arrived at his home and made resuscitation attempts for a while before arriving at the Royal Blackburn Teaching Hospital around 8:30 p.m.
The pediatric consultant, Dr. Peter Fitzmaurice, said he was called at 7:30 p.m. before taking George.
Dr. Fitzmaurice said: “The paramedics didn’t arrive for about an hour, so it was all coming back a bit: ‘What happened here?'” Because they usually only take them to the hospital.
“It simply came to our notice then that he was resuscitated at home.
An investigation into George’s death was carried out at Accrington Town Hall (pictured above) where a coroner recorded a narrative verdict after hearing that George had died of myocarditis in hospital.
“George, who was born in Burnley in 2016, arrived at around 8.30pm, but after continuous cardiac compressions there was no way out. Resuscitation was very unlikely to be successful.
“They took me to George, we did a quick assessment and I went to talk to my parents to tell him there were no signs of life.”
A post-mortem examination revealed that the cause of death was myocarditis, a “notoriously difficult disease to diagnose,” said Dr. Fitzmaurice, which can develop after a viral infection and cause inflammation of the heart muscle.
The investigation found that even if George had been sent to the hospital since the GP’s surgery, he probably would not have had an electrocardiogram (ECG) that would have detected myocarditis.
Dr. Fitzmaurice said: “From what my mother and father told me about George that day I was running, he showed no signs of heart failure during the buildup or two weeks before, so there was no indication that his heart of George was engaged.
“If you go to the hospital, it would still be difficult to diagnose, especially if there was a croup next to it.
“We would have handled the croup because that was looking you in the face and we would have carried the tachycardia [fast heart rate] downward.
‘You don’t have to bother the child too much with the croup. It is one of the most difficult things to diagnose in pediatrics. So it would depend on the level of tachycardia and at 130 we would not do an ECG on a child.
What is myocarditis?
Pictured: Normal heart muscle versus heart muscle damaged due to inflammation
Myocarditis is an inflammation of the heart caused by a viral infection.
It is defined as inflammation of the myocardium – the heart muscle – and most people recover without any complications.
In severe cases, inflammation can weaken the heart, cause an abnormal heartbeat, or even cause death.
Symptoms usually include chest pain, difficulty breathing, palpitations, or an abnormal heart rhythm.
It is usually diagnosed by tests such as an electrocardiogram, a chest x-ray, or a blood test to see if there is an infection.
Patients can treat the disease with medications aimed at regulating the heartbeat and improving heart function. Rare cases have required patients to have a device implanted in their heart to regulate their heartbeat.
The investigation found out that myocarditis could be caused by an infection and George had been “susceptible to croup”.
Dr. Fitzmaurice said: “George’s heart had a certain inflammation due to an infection at some point, which meant that he was likely to not function properly and may present in different ways, and may stop suddenly by itself or it could have stopped if something had happened.it acted as a trigger.
“The heart rate was abnormal before stopping and this is unusual in children. Where does croup come in and was it a attributable factor? It’s not easy to say what would have happened to croup with the heart in the conditions in which was.
Forensic scientist Richard Taylor asked Dr. Fitzmaurice if the group had contributed to George’s death.
The consultant said it was “impossible to say for sure”, but added: “I think the group did contribute to the irregular heartbeat, but I can’t say 100%. But myocarditis could have resulted. fatal without the croup.
George’s parents, who attended the investigation, asked Dr. Fitzmaurice if the steroids prescribed by the GP would have prevented his death.
Dr Fitzmaurice said: “It may have solved the croup, which could have taken the stress away from the heart, but myocarditis could have progressed and three weeks later it could have been in the hospital.”
Ultimately, Dr. Fitzmaurice agreed that the croup “could have been irrelevant” and that myocarditis could have been fatal on its own.
Dr. Fitzmaurice said, “I could have had a cardiac arrest that night without the croup.”
Pathologist Dr. Jo McPartland of Alder Hey Children’s Hospital, who confirmed that the medical cause of George’s death was myocarditis, said his heart was “significantly enlarged”.
Dr. McPartland said: “It was about the size of a heart expected for a nine-year-old boy and the ventricles were larger than normal.
‘Under the microscope were areas of inflammation. There were also areas where heart muscle cells had died. Even considering George’s size was larger than average, his heart weighed about 50 g more than it should have.
“It’s a rare disease, but I’ve seen some sudden and unexpected deaths in children from myocarditis. One child was admitted to the hospital, he was thought to have pneumonia, but then he died, and another died while they slept. We often don’t know it’s there until we do an autopsy and examine the heart tissue. “
George also had inflammation in his voice box, although Dr. McPartland “did not think there was a critical narrowing of the airways.”
Despite this, he said that croup was a factor that contributed to George’s death, as it can cause an irregular heartbeat that can lead to cardiac arrest, although he also found three other viruses present in his system that they could have caused myocarditis.
Recording a narrative conclusion, Mr. Taylor said: “George Thomas Spencer died on March 19, 2021 from an inflammation of his heart to which a contributing factor was most likely an undiagnosed viral infection. “.
After George’s death, his family and friends raised more than £ 8,400 to install defibrillators around Clitheroe, as well as a memorial bench at the nearby Edisford Bridge beauty site where the family enjoyed his stay.