P.L., who has a 4-year history of heart disease, was brought to the emergency room by ambulance with chest pain that radiated down her arm, dyspnea, and syncope. Her routine meds included: Lanoxin to slow and strengthen her heart beat, Inderal to support her heart rhythm, Lipitor to decrease her cholesterol, Catapres to lower her hypertension, nitroglycerin prn for chest pain, Hydro-DIURIL to eliminate fluid and decrease the workload of her heart, Diabinese for her diabetes, and Coumadin to prevent blood clots. She also took Tagamet for her stomach ulcer and several OTC preparations, including an herbal sleeping potion that she mixed in tea, and Metamucil mixed in orange juice every morning for her bowels.

Shortly after admission, P.L.'s heart rate deteriorated into full cardiac arrest. Immediate resuscitation was instituted with cardiopulmonary resuscitation (CPR), defibrillation, and a bolus of IV epinephrine. Between shocks she was given a bolus of lidocaine and a bolus of diltiazem plus repeated doses of epinephrine every 5 minutes. P.L. did not respond to resuscitation. On the death certificate, her primary cause of death was listed as cardiac arrest. Multiple secondary diagnoses were listed, including polypharmacy.

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