Natural cardiac death after stent implantation with iatrogenic injury of a coronary artery

  • Elke DoberentzEmail author
  • Anja Wegner
  • Julian Geile
  • Burkhard Madea
Images in Forensics
Part of the following topical collections:
  1. Topical Collection of Images in Forensics


In forensic practice, autopsies are regularly carried out in cases of suspected medical malpractice to determine whether a treatment resulted in death. Intraoperative deaths, as well as deaths shortly after an operation, can be particularly suspicious as iatrogenic. We report a case of a 75-year-old woman with a complaint of intermittent angina pectoris who underwent cardiac catheterization. Intra-interventionally, coronary artery dissection occurred and was stabilized by the placement of two stents. After this procedure, the patient suffered from chest pain. At 5.5 h after the procedure ended, the woman suddenly and unexpectedly died. At forensic autopsy, a hemopericardium with cardiac tamponade was found to have been caused by the rupture of a myocardial infarction that was several days old and had remained clinically unrecognized. This case report illustrates the importance of forensic autopsies in terms of external quality assurance in medicine.


Cardiac catheterization Coronary artery Coronary artery dissection Myocardial infarction 


Compliance with ethical standards

This article does not contain any studies with human participants or animals.

Conflict of interest

The corresponding author declares also on behalf of her co-authores there is no conflict of interest.


  1. 1.
    Hutchins KD, Skurnick J, Lavenhar M, Natarajan GA. Cardiac rupture in acute myocardial infarction: a reassessment. Am J Forensic Med Pathol. 2002;23:78–82.CrossRefGoogle Scholar
  2. 2.
    Dellborg M, Held P, Swedberg K, Vedin A. Rupture of myocardium: Occurence and risk factors. Br Heart J. 1985;54:11–6.CrossRefGoogle Scholar
  3. 3.
    van Mantgem JP, Becker AE. Developing cardiac rupture as initial sign of acute myocardial infarction. Br Heart J. 1976;38:1073–9.CrossRefGoogle Scholar
  4. 4.
    Matsumura K, Kin H, Matsuki R, Adachi K, Goda T, Yamamoto Y, et al. Cardiac rupture due to reinfarction in the early phase of apical myocardial infarction. Int Heart J. 2019;60:974–8.CrossRefGoogle Scholar
  5. 5.
    Reddy SG, Roberts WC. Frequency of rupture of the left ventricular free wall or ventricular septum among necropsy cases of fatal acute myocardial infarction since introduction of coronary care units. Am J Cardiol. 1989;63:906–11.CrossRefGoogle Scholar
  6. 6.
    Mann JM, Roberts WC. Rupture of the left ventricular free wall during acute myocardial infarction: analysis of 138 necropsy patients and comparison with 50 necropsy patients with acute myocardial infarction without rupture. Am J Cardiol. 1988;62:847–59.CrossRefGoogle Scholar
  7. 7.
    Reif TH, Silver MD. Role of stress concentration in the pathogenesis of cardiac rupture following acute myocardial infarction. Can J Cardiol. 1995;11:757–62.PubMedGoogle Scholar
  8. 8.
    Solomon SD, Pfeffer MA. Renin-angiotensin system and cardiac rupture after myocadial infarction. Circulation. 2002;106:2167–9.CrossRefGoogle Scholar
  9. 9.
    Khalial ME, Heller EN, Boctor FB, Brown EJ, Alhaddad IA. Ventricular free wall rupture in acute myocardial infarction. J Cardiovasc Pharmacol Ther. 2001;6:231–6.CrossRefGoogle Scholar
  10. 10.
    Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Global J Health Sci. 2012;4:65–93.Google Scholar
  11. 11.
    Pérez-Castellano N, García-Fernández MA, García EJ, Delcán JL. Dissection of the aortic sinus of Valsalva complicating coronary catheterization: cause, mechanism, evolution, and management. Catheter Cardiovasc Diagn. 1998;43:273–9.CrossRefGoogle Scholar
  12. 12.
    Carter AJ, Brinker JA. Dissection of the ascending aorta associated with coronary angiography. Am J Cardiol. 1994;73:922–3.CrossRefGoogle Scholar
  13. 13.
    Boyle AJ, Chan M, Dib J, Resar J. Catheter-induced coronary artery dissection: risk factors, prevention and management. J Invasive Cardiol. 2006;18:500–3.PubMedGoogle Scholar
  14. 14.
    Núñez-Gil IJ. Bautista D, Cerrato E, Salinas P, Varbella F, Omedè pet al. Incidence, management, and immediate- and long-term outcomes after iatrogenic aortic dissection during diagnostic or interventional coronary procedures. Circulation. 2015;131:2114–9.CrossRefGoogle Scholar
  15. 15.
    Biondi-Zoccai GG, Agostoni P, Sangiorgi GM, Airoldi F, Cosgrave J, Chieffo A, et al. Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation. Real-world eluting-stent comparative Italian retrospective evaluation study investigators. Eur Heart J. 2006;27:540–6.CrossRefGoogle Scholar
  16. 16.
    Huber MS, Mooney JF, Madison J, Mooney MR. Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol. 1991;68:467–71.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Legal MedicineUniversity of BonnBonnGermany

Personalised recommendations