Certifying a Death in Vermont

Scenario 2

A 52 year old man was raking leaves began having chest tightness and trouble catching his breath. He told his wife who immediatley took him to the emergency room. In the ER, EKG showed changes indicative of ischemia. On his way to the cardiac catheterization lab, he arrested and despite full ACLS protocols, he expired. How would you certify this death?


A man aged 52, although young, is solidly in the age when cardiac events cause sudden death. His circumstances of chest tightness and dyspenia in the setting of exertion combined with the EKG findings clearly indicate the cause of death and should be certified as:

Part I
A. Acute Myocardial Infarction
Due to, or as a consequence of:
B. Atherosclerotic cardiovascular disease
Due to, or as a consequence of:

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

Again if risk factors such as obestiy, smoking, hypertension etc., are obvious, found in the patients medical record, or elicited through conversation with the wife, they could and should be added to Part II.

Should this case be reported to the medical examiner? There is no 24 hour rule in Vermont. Hospital deaths entirely from natural disease in which a diagnosis has been made with reasonable medical probability, despite that the patient survived less than 24 hours in the hospital, need not be reported to the Medical Examiner.

As we get older, ages like 52 seem to get younger and physicians have a hard time certifying these types of death. Even families may want to know what happened for certain. Since there is no "foul play" (illicit drugs suspected, trauma or any threat to public health) even if the Medical Examiner is called jurisdiction could be waived.

This is the perfect type of case for a hospital autopsy, which can be arranged through Fletcher Allen Health Care (847-2700) by contacting the clinical pathology resident on call.

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