Coroner's Finding: Wallace., Vivienne Lorraine

73y · Female·atherosclerotic and hypertensive coronary vascular disease

Ms Wallace, a 73-year-old woman with hypertension and other comorbidities, developed atrial fibrillation during orthopaedic surgery for a fibula fracture. She was discharged on flecainide 50mg daily, metoprolol, and rivaroxaban. Within days she reported shortness of breath and fatigue, and was found deceased at home. The coroner's investigation initially closed, but was reopened after a coronial medical consultant questioned the use of flecainide. Post-mortem examination revealed significant undiagnosed cardiac disease including left ventricular hypertrophy, cardiomegaly, and coronary artery stenosis. However, the coroner accepted expert opinion from an interventional cardiologist that flecainide use was appropriate based on pre-operative testing showing a structurally normal heart, and that the prescription was consistent with international guidelines and Australian clinical practice. The death was attributed to atherosclerotic and hypertensive coronary vascular disease, not to medication choice.