A ‘naughty and happy’ four-year-old boy died of a rare underlying heart disease within three hours after a GP had sent him home, a study reads.
George Thomas Spencer, who had a history of contracting the viral infection insect, died on March 19 last year after staff at St James’ CE Primary School in Clitheroe, Lancashire, noted that his breathing was “scalded”.
When his mother Danielle picked up George from after school, she noticed that he was having difficulty breathing, so his father Terry took him to the GP.
The four-year-old boy was seen by Dr. Jill Osgood at Clitheroe Health Center on March 19th.
At a study at Accrington Town Hall yesterday, Dr. Osgood that she had experience with patients with ticks, which may be “variable in her presentation”.
But after assessing George, Dr. Osgood that she found that his heart rate, temperature and oxygen saturation were all ‘within the normal parameters’.
Four-year-old George Spencer (pictured, left, with twin brother Arthur, right) died of a rare underlying heart disease within three hours after a GP sent him home, an investigation heard
Dr. Osgood said, ‘He was very talkative and joking, speaking in whole sentences, there was no hoarse voice, but I heard noisy breathing.’
George, who has an identical twin brother named Arthur, was taken home, but later that evening, his parents noticed a worsening of his condition.
Around 7.15pm, they noticed his lips were blue and called for an ambulance.
Their neighbor, a qualified paramedic who had trained paramedics in using defibrillators, was given a nearby machine, which triggered a shock in George’s heart.
Paramedics then arrived at their home and performed resuscitation tests for some time before arriving at the Royal Blackburn Teaching Hospital around noon. 20.30.
Pediatric consultant Dr. Peter Fitzmaurice said he was called up at 19:30, before George was brought in.
Dr. Fitzmaurice said: ‘The paramedics first arrived in about an hour, so everything became a bit like, “What happened here?” because they usually only get them in the hospital.
“Then it came through that they had to revive him at home, and that was why it took so long.
An inquest into George’s death was held at Accrington Town Hall (pictured above), where a forensic pathologist recorded a narrative verdict after hearing George died of myocarditis at the hospital.
‘George, who was born in Burnley in 2016, arrived around 8.30pm but after continued cardiac compressions there had been no output. Resuscitation was very unlikely to have been successful.
“George was brought in, we made a quick assessment, and I went to talk to the parents to say there were no signs of life.”
An autopsy 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 study heard that even if George had been sent to the hospital by the GP, he probably would not have received an electrocardiogram (ECG), which would have detected myocarditis.
Dr. Fitzmaurice said: ‘From what Mom and Dad told me about George the day he ran around, he showed no sign of heart failure in the build-up or two weeks before, so there was no sign that George’s heart was compromised .
‘If you get into the hospital, it would still have been difficult to diagnose, especially if there were ticks next to it.
‘We would have managed the cross because it stared you in the face and we would have taken tachycardia with [fast heart rate] down.
‘With croup, you are not meant to disturb the child too much. 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 damaged heart muscle 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 complications.
In severe cases, the inflammation can weaken the heart, cause abnormal heartbeats or even lead to death.
Symptoms typically include chest pain, shortness of breath, palpitations or an abnormal heart rhythm.
It is typically diagnosed using tests such as an electrocardiogram, a chest x-ray or blood tests to check for infection.
Patients can treat the condition with medications that aim to regulate heart rate and improve heart function. Some rare cases have required patients to have a device implanted in their heart to regulate heartbeat.
The study heard that myocarditis may be caused by an infection, and George had been “susceptible to ticking”.
Dr. Fitzmaurice said: “George’s heart had an inflammation on it from an infection at one point, which meant it was susceptible to not functioning properly, and which can occur in different ways and can stop suddenly by itself, or it could have stopped if something had acted as a trigger.
‘The heart rhythm was abnormal before it stopped and it is unusual in children. Where does the cross get into it, and was it a attributable factor? It is not easy to say what would have happened to the cross with the heart in the state it was in. ‘
The area’s forensic pathologist Richard Taylor asked Dr. Fitzmaurice, whether the cross had contributed to George’s death.
The consultant said it was’ impossible to say for sure ‘, but added:’ I think the junction contributed to the irregular heartbeat, but I can not say it 100 per cent. But myocarditis could have been fatal without the cross. ‘
George’s parents, who participated in the investigation, asked Dr. Fitzmaurice, whether steroids prescribed by the general practitioner would have prevented his death.
Dr. Fitzmaurice said: “It may have resolved the junction, which may have taken the stress from the heart, but myocarditis could have developed, and three weeks later he could have been in the hospital.”
In the end, Dr. Fitzmaurice agrees that the junction ‘could have been irrelevant’ and that myocarditis could have proved fatal in itself.
Dr. Fitzmaurice said: “He could have had a cardiac arrest that night without the cross.”
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 the size of a heart expected for a nine-year-old child and the ventricles were larger than normal.
‘Under the microscope there were areas of inflammation. There were also areas where the heart muscle cells were dead. Even if one takes into account George’s larger than average, his heart was about 50g heavier than it should have been.
“It’s a rare condition, but I’ve seen a few cases of sudden, unexpected death in children due to myocarditis. One child was hospitalized, thought to have pneumonia, but then died, and another died in sleep. We often do not know it is there until we do an autopsy and examine the heart tissue. ‘
George also had inflammation in his voice box, though Dr. McPartland ‘did not think there was a critical airway constriction’.
Despite this, she said the cross was a contributing factor to George’s death, as it could cause an irregular heartbeat, which could result in cardiac arrest, although she also found three other viruses present in his system that could have caused myocarditis.
In recording a narrative conclusion, Mr Taylor said: ‘George Thomas Spencer died on 19 March 2021 of an inflammation of his heart which was more likely than not a contributing factor to 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 salon, where the family enjoyed spending time.