Coroner's Finding: Clark, Murray Eric

81y · Male·valvular heart disease with cardiac amyloidosis

Murray Eric Clark, 81-year-old prisoner with extensive cardiac history including aortic stenosis, sick sinus syndrome with pacemaker, and recent TAVI procedure, collapsed and died in prison infirmary on 20 September 2019. Autopsy confirmed valvular heart disease with cardiac amyloidosis as cause. Clark had multiple recent falls and episodes of syncope, including post-micturition syncope 3 days before death. He refused vital sign observations on 12 September despite staff explanation of risks. On morning of death, he was found collapsed on toilet with head injury. No CPR was performed per his documented wishes. Coroner found circumstances not suspicious and care/supervision appropriate. Clinical lesson: elderly patients with symptomatic severe aortic stenosis and syncope episodes require intensive monitoring, fall prevention strategies, and careful assessment of capacity regarding vital sign refusal, particularly post-procedurally.