Certifying a Death in Vermont

Scenario 1

1. A 66 year old woman was found dead, sitting on a couch in her home by her daughter. She was last known alive the previous evening and complained of being tired. The police contact you to certify the death. You review her records which shows she is being treated for borderline hypertension and 2 years previous suffered a stroke leaving her with a very slight residual hemiparesis of her right arm. How would you certify this death?

Discussion:


Part I

A. Atherosclerotic cardiovascular disease

Due to, or as a consequence of:
B.
Due to, or as a consequence of:
C.

Part II. OTHER SIGNIFICANT CONDITIONS: Conditions contributing to death but not resulting in the underlying cause of death in Part I - hypertensive cardiovascular disease.

From the police investigation and death scene description, no foul play is suspected, and everything points to a sudden natural death. The actual mechanism of this death may be subject to debate.

In the differential is acute cardiac arrhythmia, which could have been precipitated by an ischemic atherosclerotic occlusion (Myocardial infarct) or as a direct result of a hypertrophied heart from hypertension. Since this patient does have a history of cerebral vascular disease, a cerebral infarct or hypertensive hemorrhage may have been the terminal event.

In all scenarios the underlying cause of death would be her cardiovascular disease. In many people atherosclerosis and hypertension are found to co-exist. Deciding between the two is not always practical so the alternative, listing hypertension in Part I and Atherosclerosis in Part II would also be acceptable.

A third possibility would be to combine them in single line as hypertensive and atherosclerotic cardiovascular disease. Non-specific mechanisms such as sudden death syndrome, acute cardiopulmonary arrest or terminal arrhythmia should not be used.

If during your review of the chart you find diseases/risk factors such as hyperlipedemia, smoking or obesity you may list these in Part II.

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