Understanding the Complexity of Determining Natural Causes of Heart Attack Deaths

There are times when determining the cause of a cardiac patient's death can be extraordinarily complex. One question frequently arises: how can we be sure that a patient died from a real natural heart attack and not from a well-intended but ultimately harmful act of murder, such as administering a harmful medication?

Autopsy and Medication Detection

An autopsy can reveal if any medications were recently administered. A doctor could identify if such a medication was present that could trigger a heart attack. Autopsies are instrumental in uncovering the presence of drugs that may have led to the patient’s demise.

Harmful Medications and Cardiovascular Instability

There are many medications known to be contraindicated for patients with cardiovascular diseases. Adding a drug that increases or decreases blood pressure or heart rate can make the patient haemodynamically unstable. Certain analgesics, or pain killers, can even cause dangerously slow breathing. These medications are not only dangerous to people with heart disease but can result in death if taken, often in one dose.

Symptoms and Preceding Events

If we exclude sudden cardiac deaths due to drugs that increase the likelihood of ventricular tachycardias, death is usually not instantaneous. Haemodynamically unstable patients often experience shortness of breath or chest pain before falling into a coma. They may notify relatives or nursing professionals of their malaise before that happens. If they make it to the hospital, they usually recover if the offending medication is withdrawn.

Assumption of Natural Cause and Patient Status

The doctor who issues the death certificate considers all relevant information provided by the family or nursing professionals. They take notes on any medications present in the environment, including empty blister packs that may indicate an overdose. They also measure the patient's blood for the presence and level of intoxicating drugs, as well as drugs like digitalis, which can cause death through haemodynamic effects.

Investigative Procedures and Procedural Guarantees

If the doctor is unsure of the circumstances, they may record the cause of death as "undetermined." At this point, the police must investigate for evidence of homicide or suicide, and an autopsy is ordered. In the majority of cases, however, a severely ill patient is suspected to have died of a natural cause due to the progression of their advanced disease, and no autopsy is performed.

Limitations and Ethical Considerations

You can never be 100% sure that a death was caused by natural causes without performing an autopsy. However, drawing the line somewhere is crucial to prevent overloading the system with unnecessary investigations. If no evidence points to an unnatural death and there are no suspects, the case is closed.

By the way, murder is the unlawful, ethically unjustified killing of a person with malice aforethought. If by "well-intended murder" you mean intentionally ending a life to relieve intractable suffering, the term euthanasia is more appropriate. If you mean a "well-thought-out" murder, the mindset of these individuals is concerning. A series of unusually frequent deaths in a hospital or nursing home would likely come to light eventually.