AUTOPSY REPORT Student name: Agnes Ji Yon Jang Student ID: 307159051 PBL Group Number: 5 Encrypted case

number: 2012/ 2903/ 014 The patient was a male aged 68 who died at his house of a natural cause on the morning of 28th March. The patient was found dead in his room by his house mate who called the ambulance. The paramedics who arrived at the scene tried defibrillating him, but no sinus rhythm was detected and the patient was confirmed dead. The patient was then referred to the coroner as he had not seen his doctor in the past twelve months. It is known that the patient had a previous history of anxiety, hypothyroidism and prostate cancer. The patient had a pacemaker inserted six years ago due to coronary heart disease. He had been an alcoholic for the past thirty years; however, the patient had claimed to have been sober for the last six years. The patient's usually medications include dabigatran, sotalol, thyroxine and rabeprazole. Macroscopic pathological investigation resulted in the following findings. There was prominent calcification of the abdominal aorta whilst the ascending aorta was less than 20% occluded. The pacemaker had been attached to the posterior wall of the right ventricle in which clots were found. The mid-distal segment of the left circumflex artery was more than 80% occluded due to arterial stenosis. The basilar and vertebral arteries of the brain showed atherosclerotic changes but were patent. These pathological findings are consistent with coronary heart disease. On macroscopic observation of the liver, chronic venous congestive changes were found showing nutmeg liver. This finding reflects the patient's cardiac problems with possible right hearted failure. There were a few incidental findings worth noting - bilateral kidney cysts indicating polynephritis, focal calcifications in the spleen which may be indicative of infection (however no other findings are suggestive of this) and 4-5 gallstones which were 2mm in diameter. The death certificate is most likely to state cardiac arrhythmia due to coronary artery disease as the cause of death. The macroscopic pathological findings reflecting cardiac causes of death include more than 80% stenosis of the LCA, nutmeg liver and atherosclerotic changes of the arteries in the brain. There were no differences in the ante-mortem and post-mortem diagnosis. The patient had an extensive cardiovascular history and had not been attending appointments with the doctor for 12 months. From this, it is safe to conclude that the patients cause of death is natural.