Monthly Case: Coronary Artery Rupture

Jan safe case
What is shown?
The top image shows the heart sac opened in the chest. The sac is full of blood (cardiac tamponade). The bottom image shows the heart after the blood around it has been removed. The view is of the back of the heart. There is a T-shaped hemorrhage. The right coronary artery (RCA) wraps around from the front and is seen on the top right. The left circumflex coronary artery (LCX) also wraps around from the front and is seen the top left. The posterior descending coronary artery (PDA) branches off the RCA and travels down the middle of the back of the heart.

What was the story here?
The patient was a middle aged man who came in to the hospital short of breath for several days after getting through a cold. He had a coronary artery stent put in his right coronary artery. The procedure seemed to go well. Later in the afternoon, he became dizzy, collapsed and died. His wife spoke with the cardiologist who explained it was probably a “stroke.” The wife could not understand why, suddenly, there was a stroke right after the procedure. She also didn’t believe he had any blockages because the husband had been athletic. She requested an autopsy and retained a lawyer.

What caused the blood on the back of the heart?
The blood on the surface of the back of the heart tracks along the coronary arteries. (The coronary arteries travel over the surface of the heart). This suggests the blood came from the coronary artery itself. Because a stent was placed in the same area as the hemorrhage, this suggests that a coronary artery ruptured related to the placement of the stent. Other possibilities would be a CPR-related contusion (but that would not track along blood vessels); or a tear of the muscle heart muscle wall (but that did not happen either).

How did the person die?
After the vessel ruptured, the blood also leaked into the sac around the heart. When the heart sac fills with blood, there is no room for the heart to beat. The heart is squeezed by the blood in the sac. This can cause the patient to collapse and die. This is what happened here.

Could the rupture have happened on its own, unrelated to the procedure?
No. Spontaneous rupture of coronary arteries is documented but extremely rare. The rupture was right in the region where the stent was placed and indicated the procedure had a role in the rupture.

What else did the autopsy show?
The autopsy showed very little coronary blockage overall and a viral infection of the heart muscle (viral myocarditis).

How did the autopsy help?
The autopsy helped on a variety of levels. It determined the cause of death (coronary rupture with tamponade). It also provided information on the prior health of the heart (viral myocarditis). The patient’s shortness of breath was likely from his heart infection; and his heart infection was likely a complication from his recent viral illness (“cold”). The results also shed light on the role of the procedure in the patient’s death. Because the patient’s coronary arteries were “open,” the procedure was unnecessary. Moreover, it caused his death.

What was the impact of the autopsy results on the family’s emotions?
Difficult as the information was to consider that the death was intimately related to the care, the information from the autopsy helped the family move on from the painful restlessness of “not knowing.” At the same time the results deepened the wife’s concern regarding the cardiologist’s explanation and behavior. She began to suspect that her husband had been left to die at the time of the code (because the cardiologist did not seem to consider a diagnosis related to the heart). On top of this, she felt profoundly dismissed that there seemed to be no consideration that her husband’s death may have had any connection to a procedure hours before — a “common sense” consideration given the time frame. The autopsy results validated her concerns. Before the autopsy, the wife was left not knowing what had happened with the cardiologist telling her it was a stroke. After the autopsy, the wife knew what happened, which diminished her dependence on the cardiologist and seemed to have a liberating effect.

Why would the cardiologist suggest the cause of death was a stroke?
The cardiologist’s comments are filtered through the wife and we can’t really know what he said. If the report is accurate, it is concerning. Was this “physician hubris” (“My procedure can’t have caused a problem. I know I did everything right!”)? Was he being dismissiveness of the wife’s intelligence? Was this fear of a medical error being discovered and an attempt to deflect the wife from the “truth”? Was he really suspicious of a stroke on clinical grounds? Which option, or some other, cannot be ascertained here. But, the possibility that truth dismissed caused the patient’s death (by inattention to a procedural complication during the code) is horrific.

Summary Comment:
The issues in this case are multiple. They include a missed initial diagnosis (myocarditis); an erroneous assessment of coronary blockages (open and not blocked); a procedural complication (coronary artery rupture related to stent placement); and, possibly, misdiagnosis of stroke during the patient’s code. Probably least in question here is the actual technique of placement of the stent — the reason being that the coronary artery wall into which the stent was placed was not firm with plaque, but a pliable normal vessel. It was possibly more easily damaged by a metal stent than one shored up by at least some firm cholesterol plaque. While seemingly remote, there is a possibility that standard of care was met at various points. It would take a review of the presenting data, angiograms, the operative note, the post-operative care, and so on. However, the autopsy served to secure the truth — of benefit to the clinicians and to the wife sorely in need of information.

943 thoughts on “Monthly Case: Coronary Artery Rupture

  1. Pingback: buy cials online
  2. Pingback: buy cialis delhi
  3. Pingback: pharmacy canada
  4. Pingback: madridbet
  5. Pingback: meritroyalbet
  6. Pingback: meritroyalbet
  7. Pingback: eurocasino
  8. Pingback: canadian pharmacy
  9. Pingback: canadian viagra
  10. Pingback: aonubs.website2.me
  11. Pingback: canada medication
  12. Pingback: meritroyalbet
  13. Pingback: online pharmacy
  14. Pingback: Gz92uNNH
  15. Pingback: do-posle-psihologa
  16. Pingback: eurocasino
  17. Pingback: madridbet
  18. Pingback: buy viagra 25mg
  19. Pingback: kwersv.proweb.cz
  20. Pingback: bahis siteleri
  21. Pingback: DPTPtNqS
  22. Pingback: qQ8KZZE6
  23. Pingback: D6tuzANh
  24. Pingback: SHKALA TONOV
  25. Pingback: chelovek-iz-90-h
  26. Pingback: 3Hk12Bl
  27. Pingback: 3NOZC44
  28. Pingback: 01211
  29. Pingback: tor-lyubov-i-grom
  30. Pingback: film-tor-2023
  31. Pingback: hd-tor-2023
  32. Pingback: hdorg2.ru
  33. Pingback: JXNhGmmt
  34. Pingback: Psikholog
  35. Pingback: netstate.ru
  36. Pingback: meritroyalbet
  37. Pingback: 3aptitude
  38. Pingback: 2shelter
  39. Pingback: Link
  40. Pingback: psy
  41. Pingback: canada pharmacies
  42. Pingback: bit.ly
  43. Pingback: stats
  44. Pingback: canadian cialis
  45. Pingback: movies
  46. Pingback: gidonline
  47. Pingback: agrtyh.micro.blog
  48. Pingback: web
  49. Pingback: film.8filmov.ru
  50. Pingback: video
  51. Pingback: kaswes.proweb.cz
  52. Pingback: kvqtig.zombeek.cz
  53. Pingback: drugstore online
  54. Pingback: film
  55. Pingback: buy viagra now
  56. Pingback: canadian cialis
  57. Pingback: pharmacy
  58. Pingback: canada pharmacies
  59. Pingback: lawert.micro.blog
  60. Pingback: filmgoda.ru
  61. Pingback: rodnoe-kino-ru
  62. Pingback: stat.netstate.ru
  63. Pingback: owzpkg.zombeek.cz
  64. Pingback: buy cialis pills
  65. Pingback: kalwer.micro.blog
  66. Pingback: sY5am
  67. Pingback: buy cialis germany
  68. Pingback: AQW
  69. Pingback: buy cialis
  70. Pingback: buy cialis uk
  71. Pingback: buy cialis online
  72. Pingback: kwenzx.nethouse.ru
  73. Pingback: canadian rx
  74. Pingback: canada drug
  75. Pingback: JGXldbkj
  76. Pingback: aOuSjapt
  77. Pingback: ìûøëåíèå
  78. Pingback: psikholog moskva
  79. Pingback: A片
  80. Pingback: Dim Drakona 2023
  81. Pingback: TwnE4zl6
  82. Pingback: buy viagra delhi
  83. Pingback: psy 3CtwvjS
  84. Pingback: meriking
  85. Pingback: lalochesia
  86. Pingback: buy viagra pills
  87. Pingback: film onlinee
  88. Pingback: buy viagra now
  89. Pingback: northwestpharmacy
  90. Pingback: facts stromectol
  91. Pingback: canadian pharmacys
  92. Pingback: Northwest Pharmacy
  93. Pingback: 3qAIwwN
  94. Pingback: stromectol generic
  95. Pingback: mgfmail
  96. Pingback: video-2
  97. Pingback: sezons.store
  98. Pingback: is stromectol safe
  99. Pingback: ivermectine
  100. Pingback: 000-1
  101. Pingback: 3SoTS32
  102. Pingback: canadian rx
  103. Pingback: online drug store
  104. Pingback: pharmacy canada
  105. Pingback: rftrip.ru
  106. Pingback: madridbet
  107. Pingback: stromectol
  108. Pingback: dolpsy.ru
  109. Pingback: kin0shki.ru
  110. Pingback: 3o9cpydyue4s8.ru
  111. Pingback: mb588.ru
  112. Pingback: newsukraine.ru
  113. Pingback: canada pharmacy
  114. Pingback: meritking
  115. Pingback: edu-design.ru
  116. Pingback: tftl.ru
  117. Pingback: dose of stromectol
  118. Pingback: stromectol pill
  119. Pingback: brutv
  120. Pingback: site 2023
  121. Pingback: grandpashabet
  122. Pingback: online pharmacy
  123. Pingback: canada drug
  124. Pingback: sitestats01
  125. Pingback: 1c789.ru
  126. Pingback: cttdu.ru
  127. Pingback: canadian cialis
  128. Pingback: matchonline2023.ru
  129. Pingback: bit.ly/3OEzOZR
  130. Pingback: bit.ly/3gGFqGq
  131. Pingback: bit.ly/3ARFdXA
  132. Pingback: bit.ly/3ig2UT5
  133. Pingback: bit.ly/3GQNK0J
  134. Pingback: www
  135. Pingback: drugs for sale
  136. Pingback: icf
  137. Pingback: rusnewsweek
  138. Pingback: uluro-ado
  139. Pingback: canadian pharmacys
  140. Pingback: irannews.ru
  141. Pingback: klondayk2023
  142. Pingback: canadian viagra
  143. Pingback: canada pharmacy
  144. Pingback: 2023-film
  145. Pingback: fuck google
  146. Pingback: canadian drug
  147. Pingback: x
  148. Pingback: 9xflix
  149. Pingback: xnxx
  150. Pingback: 123movies
  151. Pingback: online drug store
  152. Pingback: canadian viagra
  153. Pingback: northwestpharmacy
  154. Pingback: kinokrad
  155. Pingback: batmanapollo
  156. Pingback: www.dibiz.comgdooc
  157. Pingback: buy viagra 25mg
  158. Pingback: furosemide vial
  159. Pingback: pharmacy canada
  160. Pingback: cialis from canada
  161. Pingback: pharmacy
  162. Pingback: canada viagra
  163. Pingback: vsovezdeisrazu
  164. Pingback: 2023
  165. Pingback: ipsychologos
  166. Pingback: yug-grib.ru
  167. Pingback: studio-tatuage.ru
  168. Pingback: running earbuds
  169. Pingback: fuck google
  170. Pingback: canada rx
  171. Pingback: video.vipspark.ru
  172. Pingback: vitaliy-abdulov.ru
  173. Pingback: psychophysics.ru
  174. Pingback: online pharmacies
  175. Pingback: buy viagra 25mg
  176. Pingback: hcq for ra
  177. Pingback: albuterol sulfate
  178. Pingback: kamagra vs viagra
  179. Pingback: strattera generic
  180. Pingback: child porn
  181. Pingback: child porn
  182. Pingback: vilitra 60
  183. Pingback: tadalista 60
  184. Pingback: pro air digihaler
  185. Pingback: augmentin 625
  186. Pingback: buy plaquenil
  187. Pingback: grandpashabet
  188. Pingback: grandpashabet
  189. Pingback: child porn
  190. Pingback: cratosroyalbet
  191. Pingback: vidalista 20 usa
  192. Pingback: vidalista 60mg
  193. Pingback: child porn
  194. Pingback: stromectol 12 mg
  195. Pingback: cenforce tablets
  196. Pingback: Cenforce 100
  197. Pingback: child porn
  198. Pingback: fildena 100mg pill
  199. Pingback: clomid
  200. Pingback: stromectol 12 mg
  201. Pingback: clomid for men
  202. Pingback: clomid 50mg mexico
  203. Pingback: discount kamagra
  204. Pingback: buy advair
  205. Pingback: kamagra boots
  206. Pingback: vermovent 12
  207. Pingback: priligy
  208. Pingback: ventolin inhaler
  209. Pingback: child porn
  210. Pingback: child porn
  211. Pingback: Sildenafil Citrate
  212. Pingback: Sildenafil 25 mg
  213. Pingback: buy vidalista
  214. Pingback: spinco
  215. Pingback: cenforce d 100
  216. Pingback: seretide inhaler
  217. Pingback: xenical rx
  218. Pingback: Sildenafil Cost
  219. Pingback: generic loniten
  220. Pingback: proscar 5mg
  221. Pingback: vermact 6
  222. Pingback: albuteral ventolin
  223. Pingback: iverjohn 3mg
  224. Pingback: children porn
  225. Pingback: vermact12
  226. Pingback: iverhope
  227. Pingback: child porn
  228. Pingback: fuck google
  229. Pingback: vidalista dose
  230. Pingback: ivermectol
  231. Pingback: is vidalista safe
  232. Pingback: fildena soft chews
  233. Pingback: vidalista
  234. Pingback: dapoxetine
  235. Pingback: vardenafil dose
  236. Pingback: clomiphene
  237. Pingback: revatio medicine
  238. Pingback: buy rybelsus
  239. Pingback: levitra buy
  240. Pingback: child porn
  241. Pingback: permotil 10mg
  242. Pingback: buy motilium
  243. Pingback: buy vardenafil
  244. Pingback: celexa citalopram
  245. Pingback: celexa online
  246. Pingback: vidalista 20
  247. Pingback: ivercid
  248. Pingback: iverguard
  249. Pingback: ivecop 3 mg
  250. Pingback: vidalista ct 20mg
  251. Pingback: amoxil pills
  252. Pingback: 3000
  253. Pingback: poxet 90
  254. Pingback: sildigra 200mg
  255. Pingback: vidalista 20
  256. Pingback: 10000
  257. Pingback: 9gm.ru
  258. Pingback: buy vidalista
  259. Pingback: depojoy
  260. Pingback: hdorg2.ru
  261. Pingback: raso.su
  262. Pingback: 50 mg clomid

Leave a Reply