“A heart attack occurs when a blood clot forms inside one of the coronary arteries — the blood vessels that ‘feed’ the heart,” says Jeffrey Barnes, MD, MSc, who is a physician at the University of Michigan. A specialist in Cardiology and Vascular Medicine at Gunn Health University says. System
When a coroner is required to investigate a person’s cause of death, they usually review the person’s medical history and the results of an autopsy.
So how do they decide if a heart attack, also known as a myocardial infarction, is the likely cause of death?
This blood clot will block blood flow to a specific area of the heart muscle.
A coroner may then be able to find a blood clot during an autopsy, which tells them a heart attack was the likely cause of death, explains Barnes, who is also a spokesperson for World Thrombosis Day.
What Exactly Do Coroners Look for?
Naida Rutherford, coroner for Richard County, Columbia, South Carolina, says that the reduced blood supply to cardiac tissue results in tissue loss, called necrosis. A coroner will be able to see this necrotic, or ischemic, tissue.
On a death certificate, you may see more than just “myocardial infarction” listed.
This is because a heart attack will often be cited as the immediate cause of death, but an underlying condition can cause a heart attack.
Contributing factors will also appear on the death certificate.
Is an Autopsy the Only Way to Determine the Cause of Death?
Barnes notes that tests such as electrocardiograms, blood tests, and CT scans may have been done while the person was alive to show that they had a heart attack.
And, Rutherford explains, a person with an extensive cardiac history can be issued a death certificate based primarily on that date.
She says that an autopsy is usually done when a person dies in the following ways:
- during a procedure, where they went into cardiac arrest while on the table
- outside of a medical facility
- within 24 hours of being seen at a medical facility
Does a Coroner Need Specific Information in Order to Do an Autopsy?
It is helpful for coroners to have some details about the person whose autopsy will be performed. But this is not necessary, as in some cases the information may not be available.
A coroner may request the following information from doctors and family members:
- Medical history, including medications, illnesses, surgeries, and scan and test results
- Sex assigned at birth
- Lifestyle choices, including a person’s occupation and activity level
- Family health history, especially if there is a heart history.
- Statements of any person who witnessed the death
- Where, when and under what circumstances did he die?
What Does an Autopsy Entail?
A pathologist performs an autopsy. It’s “a doctor with specialized training in body tissues,” says Barnes.
During the actual procedure, the pathologist makes an incision in the torso and removes the major organs. They will also open the skull to remove the brain.
Every organ, including the brain, is checked and its weight is maintained. To look for evidence of a specific cause of death, they are usually dissected and looked at closely.
“Typically,” says Rutherford, “brain, liver and kidney samples are placed under the microscope for further examination for any histological or pathological changes.
“Samples of other organs can also be taken – these are known as casts and kept for further testing if needed,” added Rutherford.
Finally, the autopsy may include blood tests.
What Distinguishes a Heart Attack as the Cause of Death From Other Cardiac Events?
“Patients who die of a heart attack usually have characteristic blood clots in the coronary arteries,” says Barnes.
Rutherford notes that other symptoms that can indicate a heart attack include an enlarged heart, dilation of the heart chambers and rupture of the blood vessels that supply the heart.
If the coroner does not find this during the autopsy, it suggests that the person died of other causes.
What other reasons can be considered?
“Some patients can die from blood clots in the lungs,” says Barnes. This is known as pulmonary embolism.
“Pulmonary embolism is the third leading cause of cardiovascular death in the United States,” adds Barnes.
Pathologists and coroners will also think about things like pneumonia, pancreatitis, peritonitis, and adverse reactions to prescription drugs or medications as possible causes of death.
How Long Does It Take to Determine the Cause of Death?
Time may vary on a case-by-case basis.
“An autopsy can take an hour or more depending on factors such as the circumstances surrounding the death, the condition of the body at the time of the autopsy, witnesses, and the criminal investigation,” says Rutherford.
If law enforcement or crime scene investigators need to be part of the process, the timeframe can be longer, she explains.
In Barnes’ experience, “an autopsy often takes a week or more to complete.”
Although a preliminary autopsy may last only a few hours and a preliminary cause of death may be determined, some tissue samples may take longer to prepare and examine.
“Only after this step is completed can the autopsy be finalized and the cause of death confirmed,” Barnes says.
The body can often be released to the family within days of the autopsy so that their loved one can be buried or cremated.
An autopsy is not always needed if a person is thought to have died of a heart attack. In some cases, coroners may use the results of tests and other scans to determine the cause of death.
If an autopsy is performed, a specialist will look for obvious evidence of a heart attack, such as a blood clot in the coronary arteries.
Not only can this help the coroner determine how a loved one died, but it can also be a way to inform family members of any conditions they may have inherited. can get and want to screen them.
If you have a friend or relative whose cause of death is being determined, know that their body will be exhumed as soon as possible so that you can make funeral arrangements.