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Forum Name: Miscellaneous Cardiology Topics
|inneedofanswers - Tue Sep 08, 2009 1:03 pm||
I lost my stepfather a little over a year ago. My mother, as well as the rest of my family are still very confused as to the treatment he received while in intensive care for 4 weeks. I can give you details if needed but did not want to begin with more info than necessary. The autopsy performed ruled his death from hypertension. He was 66 years old,took care of his body,took his blood pressure every day, and usually put the neighborhood teens to shame playing basketball. He looked 50. About a month before collapsing and being rushed to hospital he had fallen of the roof,knocked the wind out of himself, but was "fine", although did complain of a headache off and on. After many days of testing and several exploratory procedures, the neurologist found a pseudo-aneurysm the size of a golfball by that time. He underwent a treatment called Triple H prior to finding the source of bleeding. This treatment lasted about a week. He developed hydrocephalus and was retaining all these fluids and swelled up like a balloon. We thought we pulled the ventilator because he had a final stroke that did unrepairable damage to his brain stem...a complication of the aneurysm caused by trauma like the surgeon said. We expected to see this on the coroners report but instead see that he died from hypertension. Could the Triple H have made it appear that he had died of hypertension? He did not have high blood pressure prior to this incident. The coroner did not mention any other causes of death. We are very hurt and confused that maybe he would have pulled through this if it was hypertension. Thank you for your time, inneedofanswers
|John Kenyon, CNA - Thu Oct 22, 2009 11:01 pm||
Hello -- It seems once again someone has been the victim of a cavalierly-written coroner's report. Unfortunately these are frequently written,where no foul play is suspected, in overly simplified ways that do not in the least explain the terminal event. For instance, no one dies directly of hypertension, but of something secondary to it, such as a cerebral (or other vascular) hemorhage or congestive heart failure. In this instance the mechanism seems fairly plain from the ongoing medical record, but the coroner made it as short and simple as possible. Often the cause of death in a non suspicious event is written off as due to "heart failure" or "cardiac arrest." Well in fact about 99 per cent of all deaths are ultimately due to "cardiac arrest." How it came to happen is the question. In the chain of events leading to shutdown of any organism, there are preceding events. However,in the case of your stepfather there doesn't even seem to be any substantial reason to cite "hypertension" as cause, except to vary the routine. This is a cold assessment, but it's also what happens on a daily basis. Your stepfather may or may not have suffered some degree of hypertension during the course of the development of the aneurysm, but even where it is a factor it is rarely the lone culprit,since many people have hypertension but relatively few develop an aneurysm because of it, and fewer subsequently suffer a subarachnoid hemorrhage, although the majorit of people who do have such an event are around age 70, not counting those who may have had a pre-existing aneurysm which may, as with your stepfather, have had it made worse by trauma (and the fall has to be at least suspect). Also, of those who develop subarachnoid hemorrhage due to an aneurysm, very few have what is considered a "giant" one --and golfball-size qualifies as "giant." This is a very serious, very difficult situation to stabilize, and any upward variation in blood pressure could trigger a fatal bleed or rupture. This doesn't mean the subject would have died "from" hypertension, but coroners often are not interested in what they consider relatively "natural" causes, and are prone to put down almost anything that will simplify the conclusion, giving them more time to devote to foul play cases where they actually have to do some serious medical detective work.
In short, I would take the doctors' reports and the ongoing medical record up to the time your stepfather actually expired as the reasonable and logical cause, and the coroner's report to be somewhat cavalierly written and not especially useful. I think it is safe to assume there was no foul play involved, but this is often the way these cases end up. The fall is highly suspect and so is the likelihood of a pre-existing subarachnoid aneurysm which may or may not have become a giant aneurysm due to the fall. Whether the coroner's report is correct insofar as it goes is pretty much moot. Chances are even the aneurysm would have begun to leak anyway, with or without the presence of hypertension. It seems the patient in this instance was one of the unfortunate few who develop this defect, which is very rare prior to the average age of 70, at which point it becomes five times more likely regardless of other contributing issues such as head trauma or chronic hypertension.
I hope this helps clarify the issue for you somewhat, and I am extremely sorry for your loss. It may be helpful to look at this as a small statistical probability and accept the doctors' finding as the logical sequence of events. The triple-H procedure is very commonly employed and has a fair record of success with very little known contribution to morbidity or mortality, although there have been no formal studies done to prove or disprove this. The reason for lack of studies of the relative saftety is that it is often a last-resort procedure which saves some lives and not others, in a cohort of patients all of which would otherwise have likely died due to the hemorrhage.
Again, I hope this is helpful in coming to terms with this tragic event. In this case the coroner's report is just not very informative.
My best to you and the rest of the family. Please follow up with us here as needed.
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