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Forum Name: Miscellaneous Cardiology Topics

Question: Needing information on diabetes and heart disease


 lady_shark98 - Sun Dec 14, 2003 11:05 pm

My younger sister recently passed away from a massive heart attack. She was a diabetic since the age of 5 and was 33 when she passed away. Ten days prior to her death she had laproscopic gallbladder surgery in a out patient clinic. She got deathly ill with vomiting and had to spend the night. She wasn't the same after that surgery, her whole body was puffy and she was tired all the time. Five days after the surgery she was admitted to the hospital overnight due to hypoglycemia. Two days later she waws released from her doctor to return to work. Two days later she passed away. The autopsy report stated that she had a massive heart attack 4-8 days prior to her death. She also had fluid in her lungs. Shouldn't someone have picked up on her heart problems. I would think they would have done a through work up on her prior to her surgery. I am just looking for some answers and would appreciate any help someone can give me. I am still working through her death and have many questions.
 Dr. Tamer Fouad - Tue Dec 16, 2003 12:55 am

User avatar Ladyshark,
I am sorry to hear of your sisters death. Could you please post the exact phrases used in her autopsy to describe the cause of the death. Thank you.
 lady_shark98 - Tue Dec 16, 2003 9:27 am

Yes I can here is what it said was a 32 year old female with a long history of diabetes mellitus since age 5 who died suddenly and unexpectedly. She was status post cholecystectomy approximately one and a half weeks ago at Allan Memorial Hospital in Waterloo. The family consented to an autopsy to determine the cause of death. The family also consented to tissue donation. The autopsy is performed at 9:10 a.m. on 10/27/2003 with Tina Friday assisting. CAUSE OF DEATH:
IMMEDIATE: LARGE ANTERIOR ACUTE MYOCARDIAL INFARCTION.
BASIC: SEVERE CORONARY ARTERY ATHEROSCLEROSIS WITH ACUTEL Y RUPTURED PLAQUE AND STENOSIS OF THE LEFT ANTERIOR DESCENDING CQRONARY ARTERY
MANNER OF DEATH: NATURAL.

FINDINGS:
1. LONG HISTORY OF DIABETES MELLITUS.
2. STATUS-POST RECENT CHOLECYSTECTOMY.
3. BILATERAL PULMONARY CONGESTION AND EDEMA 4. BILATERAL RENAL CORTICAL INFARCTS, REMOTE. 5. STATUS POST TISSUE DONATION. 6. RIGHT OVARIAN ADENOFIBROMA. 7. ABDOMINAL ADHESIONS.
8. CENTRILOBULAR LIVER CONGESl11ON, MILD. 9. AGONAL ASPIRATION, LUNGS.
10. UTERINE SEROSAL ADHESIONS. 11. L YMPHOCYTIC THYROIDITIS.
CORONARY ARTERY (Block 1A)" Sections of the left anterior descending coronary artery reveal severe atherosclerosis with stenosis of the lumen. There is a ruptured plaque with adherent fibrin thrombus which correlates with the myocardial infarct. The ruptured plaque has exposed aggregates of fibrin and cholesterol crystals.
Cardiovascular system: The heart weighs 340 grams and the epicardium is note to be congested. THe origin and insertion of coronary arteries is normal. Cut sections of the vessel show severe athrosclerosis, especially in the proximal left anterior descending coronary artery which is nearly completely occluded and heavily calcified. Cut sections through the heart reveal an acute myocardial infarct involving the anterior left ventricle and anterior septum. There is softening of the myocardium with a hemorragic appearance. No perforation is identified. The valves are found normally and no pumlonary emboli are seen. The descending aorta shows moderate athrosclerosis.
Clinical Summary
was a 33 year old female with a history of diabetes melitis and status post cholecystectomy who died suddenly and unexpectedly. The immediate cause of death in this case is a myocardial infarction (heart attack) which appears to be approximately 4-8 days old. This is.associated with a ruptured atherosclerotic plaque and partial thrombosis of the left anterior descending coronary artery. Clearly her diabetes would have been a significant risk factor for development of the atherosclerotic lesion and subsequent infarct. The size and location of this infarct would explain the death in this patient. Other findings in this autopsy included arteriolonephrosclerosis and small infarcts of the kidneys also related to her diabetes and atherosclerosis, agonal aspiration of gastric contents in the lungs, an incidental serous adenofibrosis of the right ovary, lymphocytic thyroiditis and an absent gallbladder. The body was status post tissue donation which was accomplished successfully.
Thanks for your prompt reply to my question.
 Dr. Tamer Fouad - Tue Dec 16, 2003 11:06 am

User avatar Lady_shark,
I think what the report means is 4-8 days since the date of the forencic examination. When is this report dated? Was it done within a week of the death? As the report says her diabetes predisposes her to atherosclerosis. This is a process which takes years to form. Its ofcourse the main cause of her infarction. Acute massive myocardial infarction is a process the kills right away (suddenly). The point we can also note here is that her diabetes may predispose her to have a silent myocardial infarction where she wont even feel the pain that normally accompanies a heart attack because the nerves conveying pain have been damaged by diabetes. The massive infarct leads to sudden failure of the heart which means that blood accumulates behind the heart and is not driven forwards to the rest of the body. Hence, the fluids in her lungs which again would have happened suddenly as a result of the sudden as a result of the sudden heart failure.
 lady_shark98 - Tue Dec 16, 2003 12:37 pm

My sister passed away on October 26 and the autopsy is dated 10-27-03
10/26/2003 DOB/AGE: 1/11/1970 (Age: 33) BILLING#: 2912 DATE OF AUTOPSY: 10/27/2003
 Dr. Tamer Fouad - Tue Dec 16, 2003 2:38 pm

User avatar Ladyshark,
My appologies I was under the impression that because she was discharged after the hypoglycemia that meant she was in perfect condition. On revising your message i noticed that you said her whole body was puffy, she was tired all the time (symptoms that could be attributed to heart failure). Those seem to be just around the time her silent infarction happened. I do find it rather strange that she went through all of this unnoticed. Her ability to endure the massive infarction, heart failure were rather incredible. Maybe you should have a talk with her doctor and tell me what his explanation was. The picture here is rather sketchy I'm afraid.

How was her breathing during the days after the surgery?
 lady_shark98 - Tue Dec 16, 2003 4:49 pm

Her breathing appeared normal to me not labored or rapid. Am I able to get her medical records with the new HIPPA regulations? I guess what I was really getting at is how could someone miss this. If you were gonna due surgery on a young woman with brittle diabetes and a family history of cardiovascular disease would you do a cardiac workup prior to doing this surgery? Couldn't the symptom of gall bladder disease actually have been caused from her severe athrosclerosis?
 lady_shark98 - Tue Dec 16, 2003 9:41 pm

When she was admitted to the hospital her temperature was below normal. Is this indicative with a low blood sugar?
 Dr. Tamer Fouad - Wed Dec 17, 2003 12:36 am

User avatar It could be many things, possibly low blood pressure (due to the heart failure).
 lady_shark98 - Wed Dec 17, 2003 9:49 pm

I would like to thank you for taking the time to answer my questions. It's greatly appreciated. If I would want to get my sisters medical records do I need a lawyer or could I just request them in writing?
 Dr. Tamer Fouad - Thu Dec 18, 2003 1:39 am

User avatar All hospitals, and most doctors' offices, have a release form that you can use to request the medical records. In most cases you can request the medical information directly from the doctor's office or medical records department at a hospital. You may also need to attach forms indicating your legal right to the medical records. Each medical facility has slightly different regulations about the paperwork required for obtaining a relative's medical records. It is best to contact the medical facility before submitting a request.

Often there is no charge to request medical records if the medical records are sent directly to a health professional. If you request that the medical records be sent to you, there may be a fee. The cost can be surprisingly expensive if there are lots of medical records because there are per page copying charges and sometimes additional charges for the time of the person making the copies.

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