You may remember my previous post regarding my brother in law who died of a heart attack, aged 34, no previous heart problems. Jim did have some health problems like depression, and was often tired, irritable, stressed. He also had a back problem. He lost his job after 17 years and experienced severe bullying. He was heart broken when he was asked to resign. Could these have contributed to his heart attack? Could the symptoms of depression have been the symptoms of silent ischemic heart disease? He had an ECG (I think its called) in 1999 and it was all clear. How long can you have heart disease before its fatal? Is a clot regarded as heart disease? Could he have had a clot and he was jsut a walking time bomb?

Many questions I know - but I am new to this and his death just doesnt make sense.

Thanks Tina

Tiina,
It is so shocking and sad to hear about your brother in law.

He probably had a thrombosis - ie a sudden formation of a blood clot on a small coronary block or an atrial spasm - all othen probable reasons even chance of a sudden cardiac death trigggered by electrical problems is remote in persons of his age.

Depression he was undergoing was probaly not a symptom, but a CAUSE.

IF AT ALL he had coronary artery disease, he may have had it during the last check up, but since his arteries are fully clogged, ECGS (other while doing than stress tests) may not have revealed anything. Further, for a thrombosis to happen, there need not be a very substantial artery closure. Small and soft plaque usually ruptures and causes clots to form while old, hard and big blockages are generally safe.


Depression, stress and trauma can literally break a heart by boosting arterial plaque formation and pushing up cholesterol levels or even much worse, it can cause a healthy artery to suddenly contract and close, though the patient has no coronary artery disease.

Hello Tiina,
Continual stress does flood the body with adrenalin, which increases blood pressue and the heart rate. I am not medically trained, but to me this is the way stress and heart disease are related. I am not saying, of course, that stress caused (in itself) your brother-in-law's death, which I am sorry to hear about. Sudden death from cardiac causes is not restricted to "heart attack" (ischemic heart disease) caused by a lack of blood supply to the heart. As you know, this is usually due to clot formation in the coronary arteries, where the arteries are damaged by arteriosclerosis.This usually takes place over some years, without the person knowing about it, until they have pain from the heart region after exertion (Angina). Some abnormal heart rhythms, which are mediated by electrical impulses, which normally initiate and control the heart's action,can also cause sudden death.This, of course, is quite different from what we call "heart attacks", but is a factor to consider when young people suddenly have a cardiac arrest.I don't think depression itself, would be a symtom of impending cardiac arrest, but depression, and the anxiety that usually occurs with it,certainly places a strain on our well-being and certainly has an adverse effect on our functioning.I can well understand your seeking out answers to the tragic death of your "young" brother-in-law. It is difficult to deal with such an event, but I hope you are able to deal with the situation, and also, of course, help your sister.
Regards, Excelsior

Hi Tiina,

If I remember correctly from your prior post, the Coroner's determination of death was due to ischemia!

It seems to me thrombosis, embolism or aneurism would be part of the Coroner's report. CAD can cause abnormal heart rhythms and that may not be seen by a coroner.

One can have blocked arteries and not have any pain or noticable events until heart failure. I have a totally blocked LAD, a 90% stented and a 70% blocked. I never had any pain!! Pulmonary edema was the disclosing event.

Quote Brian: Depression, stress and trauma can literally break a heart by boosting arterial plaque formation and pushing up cholesterol levels or even much worse, it can cause a healthy artery to suddenly contract and close, though the patient has no coronary artery disease.

I believe that is the most likely event considering the Coroner's inquest. There may have been a spasm in a narrowed artery causing a massve heart attack and death would be quick.

Thanks so much for your replies.

Apparently there will be another detailed coroner's report available within 26 weeks. Do you know if the reports are accurate or just speculation? I suppose what I am saying is, should I be looking for answers or is it just part of the grief response with such a sudden death?

Please let me know if my questions and issues are out of line in this health board. I dont want to me freaking people out.

Hello again Tiina,
I think your reaction is healthy and normal, and certainly this is a good forum to air your grief and concerns.Please continue, as people are willing and happy to support you at this time.
The Coroner's Report would include the results of an autopsy if one was done, and it almost certainly would be in the case of sudden death of a young person.It is possible that even a thorough inspection of the vital organs will not reveal 100% the cause of death. But you would expect to find out the cause. I would think (I am not medically trained) that a "heart attack" due to ischaemic heart disease would be very apparent to the Pathologist. However, a cardiac arrest following dangerous heart rhythms,as noted by kenkeith, may leave little or no trace. Sometimes a "minor" heart attack can lead to a dangerous rhythm and cardiac arrest.So it is not absolutely clear what caused a person's death, or how to express the "cause". Tiina you should expect to find out from the final report, with a high degree of probability, the cause of of your brother-in-law's death. Doctor's often deal in probabilities. For example, there is an 85% chance that "x" will happen etc etc.
The Coroner's Report is a legal document, informed by professionals, so you can have a lot of faith in the findings.It is very human and normal to want to know what caused the tragedy. I wish you all the best, and look after yourself too.
Regards, Excel;sior

For public safety reasons, a coroner's report is mandatory in must jurisdictions when there is an unexplained death or suspicious circimstances. Usually the deceased person is under a doctor's care and the doctor will sign the certificate of death and provide the reason. If the coroner is doing his/her job, the report will be precise, accurate and not speculation.

It is natural for some people to reasonably understand the circumstances before there is closure and of course that would be part of the grief process.

Thanks so much for your replies.

Apparently there will be another detailed coroner's report available within 26 weeks. Do you know if the reports are accurate or just speculation? I suppose what I am saying is, should I be looking for answers or is it just part of the grief response with such a sudden death?

Please let me know if my questions and issues are out of line in this health board. I dont want to me freaking people out.

I'm sorry for your loss. I lost my husband a few weeks ago to sudden death and as someone stated before it's mandatory in many places that an autopsy be performed when someone dies fairly young (he was 54) and suddenly. The autopsy report showed he died of Hypertrophic Cardiomyopathy and had never been diagnosed even though the medical examiner said he'd had it for years. It kills over 450,000 people a year and sadly it's missed in diagnois alot .. usually it's diagnosed as asthma. My husband had been to ER 3 times in the past 5 weeks with breathing problems and EKG's were done each time and they told him to see a pulmonary doc. Often it's discovered in autopsy. This is the disease that kills so many young people suddenly. So glad they did an autopsy as this is a highly genetic disease and most of the men in his family have died in similar ways but never had an autopsy done. Given the genetics I can now have my son tested .. his dying the way he did my save our son's life someday ... I'm sad at how many in his family died of this when it's actually very treatable. I've spent many hours researching it and it's good you are asking questions...for me it's helped the healing process. Good luck.

Thank you so much for your support and information, and welcoming nature! It does help me to read all your posts. Closure is important with this sad death so I look forward to (wrong words I know!), to finding out more of my brother in law's cause of death. Oh yeah - one more important question, is ischemic heart disease hereditary or congenital? Is there a risk that my nephew who is now 21 months, may have/ get it? I mean, where does hereditary start? There was no history in my B-I-L's family?? Ta, Tina