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Had high blood pressure, smoked, overweight, asthma. Had nose bleeding. What could be the cause of death

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Last weekend I found my son deceased and the coroner said probable myocardial infarction. He'd been gone probably about 2 days. There was a significant nose bleed that occurred at some point in the process and I wondered if this was due to a potential aneurism that caused the infarction versus a blood clot? He had high blood pressure, but was on meds, smoked, overweight and 17 years worth of chronic facial pain for stress to his body. Early history of asthma which occasionally bothered him as an adult but was bad as a child. And how does one tell post death, difference of a brain aneurism vs a cardiac infarction. It looked like he never even moved after the event happened.
Posted Fri, 24 May 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 1 hour later
Respected XXXXXXX

It's really sad to hear about your son.

1.     There are no telltale signs to say or pinpoint heart attack as a cause of death. Only an infarction of heart on autopsy, along with a fresh thrombus in coronaries (blood vessels supplying to heart) (when performed early after death) may indicate that death was due to heart attack. A heart attack (myocardial infarction) will be associated with nasal bleeding only as a result of fall and trauma to nose or at times high blood pressure at time of heart attack may cause nasal bleeding.

2.     Neither there will be any signs which can surely say that death was due to intracranial (I/C) bleed. There may be signs like unequal pupils, different directions of gaze, which may at times suggest the intracranial bleed. Only an autopsy finding of blood in the intracranial cavity will confirm this.

3. No, an aneurysmal bleed in brain will not trickle to nose and cause nasal bleeding. This is not feasible. Only traumatic I/C bleeding (where damage the skull is there) coming from skull, will appear in nose. Other causes of simultaneous bleeding can be fall and trauma to nose after I/C bleed, trauma to both skull & nose, Systemic disorders like high blood pressure, Bleeding disorders (coagulopathies), Drugs causing thinning of blood (anticoagulants) can also lead to simultaneous bleeding.

Post-mortem appearance of bloody fluid in nose may occur spontaneously but at ~2 weeks of death.

I hope you got some insight into these mechanisms. Feel free for any clarification.

Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Had high blood pressure, smoked, overweight, asthma. Had nose bleeding. What could be the cause of death 12 hours later
I don't think it looked like he hit his nose due to the positioning of the head and body, so the most likely scenario from what you said is that there was a hypertensive event with the heart attack. They do not do autopsies automatically here unless the coroner can not explain the cause of death on site. And given his history, this did seem a likely explanation. They did take blood and were going to do a toxocology report...takes 3 months with only 1 lab for the state of AR. I don't know of anything he was taking though that would have caused heart attack, more likely lethargy and difficulty breathing, in which case I don't think he'd been trying to hook up something to the TV. So thank you for your answer. It helps understand the possible processes.
Answered by Dr. Sukhvinder Singh 35 minutes later
Thanks Ma'm
For your kind words.
Sukhvinder XXXXXXX
Above answer was peer-reviewed by
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