Thursday, March 1, 2018

Heart attack with normal angiography or normal post mortem

Dr KK Aggarwal
Recipient of Padma Shri

The death of actress Sridevi was due to accidental drowning in a bath tub following loss of consciousness in a hotel in Dubai. This was the conclusion of the post-mortem report and foul play has been ruled out. Dubai police said that the case has been closed.

However, the cause of unconsciousness has not yet been conclusively found. Traces of alcohol were found in blood, and it has been suggested that this may have led to the accidental drowning.

Though the post mortem has ruled out heart attack, it still remains the most likely initiating event for loss of unconsciousness or gasping, which may have been due to ventricular tachycardia/fibrillation.

So, can one have a normal angiography or normal post-mortem after a heart attack? The answer is yes.

There are two types of heart attacks: Type I versus type II heart attack.

Most patients with acute heart attack will have obstructive (blockages) atherosclerotic (cholesterol deposition) coronary artery stenoses (narrowing) with acute thrombosis (clot) as the underlying pathology.

However, some patients (up to 28%) will not have significant epicardial coronary artery disease when coronary angiography is performed or post mortem is done. These patients are defined as having a type 2 heart attack, which is defined as a heart attack consequent to increased oxygen demand or decreased supply (coronary endothelial dysfunction, coronary artery spasm, coronary artery embolus, tachy / bradyarrhythmias, anemia, respiratory failure, hypertension, or hypotension).

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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