A 63-year-old man with complex medical and psychiatric history died of coronary artery thrombosis while on authorized leave from psychiatric admission. He had severe triple-vessel coronary artery disease with acute thrombosis. During hospitalization for bipolar disorder, his presenting complaint of vomiting was appropriately investigated by his treating resident doctor and attributed to a known long-standing complication of previous oesophagectomy. Physical examination was reassuring, blood work was normal, and leave was granted progressively. The coroner found his detention lawful, treatment appropriate, and made no recommendations. The case highlights the challenge of distinguishing cardiac symptoms from gastrointestinal complaints in complex patients, and the importance of comprehensive cardiovascular assessment in high-risk individuals, though acute coronary events may present atypically.
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