Apelu, Faaee - Non-inquest findings

41y · Male·Myocardial infarction secondary to coronary atherosclerosis, resulting in sudden cardiac death from ventricular fibrillation

A 41-year-old man with multiple cardiac risk factors (hypertension, hyperlipidemia, obesity, obstructive sleep apnoea, family history) presented with chest pain and was diagnosed with acute coronary syndrome. Coronary angiography identified a 99% stenosis in the right coronary artery which was stented with excellent angiographic result. He was discharged the following day on dual antiplatelet therapy, statin, and ACE inhibitor. Four days later he suffered sudden cardiac death from ventricular fibrillation. Autopsy revealed severe multi-vessel coronary artery disease not detected on angiography, including critical LAD stenosis and disease upstream/downstream of the stent. The coroner concluded angiographic limitations (suboptimal opacification, streaming artefact) prevented detection of additional lesions. While discharge timing may have been somewhat premature, early discharge would likely have occurred regardless, and was not a significant factor in death. The primary cause was sudden cardiac arrhythmia secondary to recent myocardial infarction.