Death of a young mother after sixth delivery due to coronary artery dissection

S M H M K Senanayake

doi:10.4038/mljsl.v4i2.7339

Abstract

Thirty six (36) years old female developed burning chest pain, was treated for gastritis by the general practitioner and was found dead on admission to the hospital 12 hours later. Postmortem examination showed hemorrhage around left coronary artery, left circumflex artery, anterior descending artery and branches, inner walls of coronary arteries compressed and lumens were collapsed. Lateral wall of the left ventricle showed pale area with hemorrhages. Cause of death was established as pulmonary oedema due to myocardial infarction following coronary artery dissection during puerperium. Most common causes for coronary artery dissection are coronary atherosclerosis and spontaneous peri-partum dissection. In peri-partum coronary artery dissections eosinophilic infiltration are seen in coronary adventitia without atherosclerosis. High estrogen levels or eosinophilic granulations contain lytic substances are thought to break down medial-adventitial layers leading to coronary artery dissection. Spontaneous coronary artery dissection occurs in relatively younger population with a predilection for women. The mean age of patients is 35 to 40 years. Left anterior descending coronary artery was the most common to involve. Some cases are diagnosed at the autopsy due to sudden deaths and some cases are presented as unstable angina and myocardial infarction. Spontaneous coronary artery dissection is a coronary abnormality needs attention in autopsies of any young person with history of chest pain or sudden death, especially women in the peri-partum period.

Highlights

IntroductionThirty six years old female developed burning pain in chest and throat on 18th day after 6th normal delivery
Maternal deaths are very important because it creates severe burden for the family, leads to health department inquiry about the clinical and antenatal managements, demand a post autopsy discussion by the relations with forensic medicine practitioner
Even though coronary artery dissection is a rare cause of sudden death, it is an important cause of maternal deaths because most common causes for coronary artery dissection are coronary atherosclerosis and spontaneous peri-partum dissection.[1]

Summary

Introduction

Thirty six years old female developed burning pain in chest and throat on 18th day after 6th normal delivery. She was treated for gastritis by the general practitioner and was reassured that investigations are not necessary at the moment. Hemorrhage along the surface of anterior descending artery and left circumflex artery (fig.). Lateral wall of left ventricle showed pale area with hemorrhages compatible with acute myocardial infarction (fig.). Histology showed blood in the walls of coronary arteries (fig, 4).Cause of death was established as myocardial infarction due to spontaneous coronary artery dissection during the puerperium. Myocardial infarction of the left ventricle (A- Pale area, B- anterior descending artery with blood in the wall)

Discussion

Conclusion