Coronial
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Coroner's Finding: BLAIN Kathleen Olive Florence

Deceased

Kathleen Olive Florence Blain

Demographics

79y, female

Date of death

2011-10-14

Finding date

2014-11-28

Cause of death

acute myocardial infarction and acute pulmonary oedema

AI-generated summary

A 79-year-old woman with stroke and cardiac history was admitted for rehabilitation but developed treatment-resistant depression. Despite comprehensive multidisciplinary management including medication trials (mirtazapine, citalopram, venlafaxine), nasogastric and PEG feeding support, and five ECT treatments (preceded by appropriate cardiology and neurology clearance), her condition deteriorated. She had poor engagement with rehabilitation, reduced oral intake, and progressive physical deconditioning. The coroner found her medical treatment was appropriate throughout and made no recommendations. The clinical lesson is that treatment-resistant depression in elderly patients with multiple comorbidities requires intensive coordinated care, but some patients may not respond despite optimal interventions. Early consideration of prognosis and goals of care, which appears to have occurred here, is essential.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.

Specialties

psychiatrycardiologyneurologygeneral medicinedieteticsphysiotherapy

Drugs involved

mirtazapinecitalopramdesvenlafaxinevenlafaxine

Clinical conditions

acute myocardial infarctionacute pulmonary oedemastroketreatment-resistant depressionnon-ST elevation myocardial infarction

Procedures

nasogastric tube insertionPEG tube insertionelectroconvulsive therapydobutamine stress echocardiogram

Contributing factors

  • treatment-resistant depression
  • poor engagement with rehabilitation
  • reduced oral intake and nutritional status
  • physical deconditioning
  • pre-existing stroke with disabling deficits
  • pre-existing cardiac disease
Full text

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