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Expired due to heart attack. But noticed nose bleeds and strangely purple color on cheeks. Opinion?

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Good morning, I found this excellent site and I write from Italy for an answer that I never found. Last week is dead my dear grandmother (85 years old, with hypertension) who lived with us.
In the morning we had breakfast together and I observed that occasionally interrupted the speech and mumbled the words. We put her to bed and called the doctor but she was panting and in a short time has worsened, until expiry.
The doctor determined that it was a heart attack, but I was left with a strong doubt that now I explain. In the first 24 hours after death, his face was relaxed, with the classic pallor of the dead. After 24 hours, while we waited for the closing of the coffin, I have observed that came out a little bit of nosebleeds from the nose and the lower part of the cheeks were strangely purple, probably due to accumulation of blood.
For these reasons, I always thought that my grandmother had a brain hemorrhage or something like that. I say this because, in the supine position with the head on the pillow the blood can not proceed uphill, while it can come down from the head. I'd appreciate your opinion about the end of this dear person that I loved her so much. Thank you.
Posted Sun, 3 Nov 2013 in Brain and Spine
Answered by Dr. Mahesh Koregol 53 minutes later
Brief Answer:
Possibility of both

Detailed Answer:

You are right in a way but medical science has different possibilities.

It is possible that your grandmother had brain haemorrhage because 1) She was a known hypertensive and 2) She had iterrupted words and mumbled speech. These 2 factors strongly go infavor of haemorrhage in brain.

But hypertensive patients also have cardiac roblems especially at this age and hence she might have experienced a heart attack simultaneously which lead rapid deterioration. Since her condition deteriorated soon it is difficult to analyze unless we have ECG for heart attack or brain scan for haemorrhage.

Nose bleed cannot be attributed to either as it is 24 hours after death which could be due to postmortem changes in the body and could be bleed from nose only and nothing to do with brain.

Hence it appears that she had brain haemorrhage in beginning but slowly accompanied by heart attack. But it is difficult to predict both. I pray her soul rests in peace.

Dr. Mahesh Koregol
Above answer was peer-reviewed by
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