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When a coroner needs to investigate what caused a person’s death, they usually examine that person’s medical history and autopsy results.

So how do they decide that a heart attack, also known as a myocardial infarction, is the likely cause of death?

“A heart attack occurs when a blood clot forms inside one of the coronary arteries — these are the blood vessels that ‘feed’ the heart,” says Geoffrey Barnes, MD, MSC, a cardiologist and vascular medicine specialist at the University of Michigan Health System.

That blood clot will block the flow of blood to a particular part of the heart muscle.

A coroner may then be able to find that blood clot during an autopsy, which tells them that a heart attack was the likely cause of death, explains Barnes, who is also a spokesperson for World Thrombosis Day.

Naida Rutherford, who is the coroner for Richard County, Columbia, South Carolina, says that limited blood supply to cardiac tissues results in the tissue eventually dying off, called necrosis. A coroner will be able to see this necrotic, or ischemic, tissue.

On a death certificate, you may see more than just “myocardial infarction” listed.

That’s because a heart attack will often be stated as the immediate cause of death, but an underlying condition may have contributed to or caused the heart attack.

Any contributing factors will also appear on the death certificate.

Not always.

Tests such as electrocardiograms, blood tests, and CT scans may have been performed when the person was alive to show that they’d had a heart attack, notes Barnes.

And, explains Rutherford, a person with an extensive cardiac history may have a death certificate issued primarily based on that history.

She says an autopsy is typically performed when a person dies in the following ways:

  • suddenly
  • unexpectedly
  • outside of a medical facility
  • within 24 hours of being seen at a medical facility
  • during a procedure, where they went into cardiac arrest while on the table

It’s helpful for coroners to have some details about the person who will be having an autopsy. But it isn’t vital, since information might not be available in some cases.

A coroner may request the following information from doctors and family members:

  • age
  • sex assigned at birth
  • lifestyle choices, including a person’s occupation and activity levels
  • where, when, and in which circumstances they died in
  • statements from anyone who witnessed the death
  • medical history, including medications, illnesses, surgeries, and results of scans and tests
  • family health history, particularly if there is any cardiac history

A pathologist performs an autopsy. This is “a physician with specialized training in tissues of the body,” says Barnes.

During the actual procedure, the pathologist makes an incision over the torso and removes the major organs. They’ll also open the skull to remove the brain.

Each organ, including the brain, is examined and weighed while it’s intact. They’re usually dissected and looked at in closer detail, too, to look for evidence of a particular cause of death.

“Typically,” Rutherford says, “brain, liver, and kidney samples are kept for further evaluation under a microscope for any histological or pathological changes.

“Other organ samples can be taken as well —these are known as cassettes and held for further testing if needed,” Rutherford adds.

Finally, an autopsy may involve blood tests.

“Patients who die from a heart attack will usually have a characteristic blood clot found in the coronary arteries,” says Barnes.

Other signs that may indicate a heart attack include an enlarged heart, dilation of the chambers of the heart, and breakdown of the vessels supplying blood to the heart, Rutherford notes.

If the coroner doesn’t find these during an autopsy, it suggests the person died from other causes.

What other causes might be considered?

“Some patients may die from a blood clot in the lung,” says Barnes. This is known as a pulmonary embolism.

“Pulmonary embolism is the third leading cause of cardiovascular death in the United States,” adds Barnes.

Pathologists and coroners will also think about things like pneumonia, pancreatitis, peritonitis, and adverse reactions to prescribed medications or drugs as potential causes of death.

The time can vary on a case-by-case basis.

“An autopsy can take an hour or more based on the case such as circumstances surrounding the death, state of the body at the time of autopsy, witnesses, and criminal investigations,” says Rutherford.

She explains that this timeframe may be longer if law enforcement or crime scene investigators need to be part of the process.

In Barnes’ experience, “an autopsy will often take a week or more to be completed.”

Although the initial autopsy may only last a few hours and a preliminary cause of death may be identified, some tissue samples may take longer to be prepared and examined.

“Only after that step has been completed can the autopsy be finalized and a cause of death confirmed,” says Barnes.

The body can often be released to the family within a couple of days of an autopsy so their loved one can be buried or cremated.

An autopsy isn’t always needed if a person is thought to have died of a heart attack. In some cases, coroners can use the results of tests and other scans to determine a cause of death.

If an autopsy is carried out, a specialist will look for clear evidence of a heart attack, such as a blood clot in the coronary arteries.

Not only can this help the coroner determine how a loved one died, but it can also be a way to inform family members of any conditions that they could inherit and wish to be screened for.

If you have a friend or relative whose cause of death is being determined, know that their body will be released as soon as possible so that you can make funeral arrangements.

Lauren Sharkey is a U.K.-based journalist and author specializing in women’s issues. When she isn’t trying to discover a way to banish migraine, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.