Finding into death of Mrs K

81y · Female·Cardiac tamponade secondary to dissection of ascending aorta

An 81-year-old woman with hypertension and hypercholesterolaemia presented to the ED with sudden-onset central chest pain radiating to the jaw. Despite appropriate initial assessment and ruling out acute coronary syndrome via troponin and ECG, she was discharged with undiagnosed chest pain after a 'chest pain pathway' without further investigation (no chest X-ray or imaging). She re-presented 4 days later with persistent symptoms, was admitted under cardiology with suspected NSTEMI, and died from cardiac tamponade due to aortic dissection rupture while awaiting CTPA. The coroner found that aortic dissection was likely considered but discounted based on absence of 'classic' features (ripping pain, pulse deficits, widened mediastinum). Critical lessons: absent classic features cannot exclude aortic dissection (anterior chest pain is common in Type A); patients discharged from chest pain pathways with persistent undiagnosed symptoms require further investigation; high-quality history-taking is essential; and bedside ultrasound during PEA arrest might have identified reversible causes such as cardiac tamponade.