When Anita passed away, they doctor’s told me there seemed to me “nothing physically wrong” with her. But how could someone in seemingly good health and having just had a doctor’s checkup and blood tests four days previous suddenly die?
We had to wait four and a half months for the death certificate because the coroner’s office had to run blood and tissue tests to determine a cause of death (they will not issue a death certificate without a cause of death). The immediate cause: sudden death associated with enlarged heart. Other significant conditions: placental abruption.
So what does that mean exactly? I called Anita’s OB/GYN and the coroner’s office to learn more. Here are the specifics:
Anita’s heart was “mildly enlarged”. It measured 420 grams (upper end of normal is 360 grams). On the initial physical autopsy, it did not appear large enough to cause death, which is why the lab tissue samples were necessary. The lab results showed the right ventricle had “fatty infiltration” aka myocardial fibrosis (fibrous tissue). It was only a mild amount, but enough to force the left ventricle to enlarge because it had to work extra hard. There were no congenital problems – meaning this was not a defect developed in utero, but could have been a genetic trait or a developed condition. An enlarged heart falls under the broad category of “heart disease”.
Anita also had a placental abruption meaning the placenta had disconnected from her which causes a lot of pain and bleeding. They did not know if was a contributing factor or a complication of her death because they could not tell if it happened before or after her heart swelled.
They also found mild acute pneumonia in her lungs, but not enough to warrant mentioning on the death certificate.
The coroner’s opinion was that Anita’s heart stopped before the abruption since she was not complaining of debilitating pain that is associated with abruption. Why her heart swelled is a mystery, unknowable. They said that this type of heart condition is virtually undetectable.
Thanks to Google, I found some more information about this type of thing.
Heart disease is a major complication of pregnancy. It occurs in about 1 percent of all pregnancies. Sometimes, heart disease is known before pregnancy. However, some women may have unknown heart conditions that only become apparent during pregnancy.
During pregnancy, the heart normally enlarged slightly. It has to work extra hard as the baby develops.
An enlarged heart isn’t a condition in itself, but a symptom of an underlying problem that is causing the heart to work harder than normal. The range of underlying problems falls generally into two main categories – pathological (linked to actual disease of the heart muscle) and physiological (linked to other causes which are overworking the heart muscle, such as high blood pressure). In some cases, an enlarged heart is asymptomatic (has no symptoms).
Again, we won’t know if Anita had some undetected heart muscle disease or if other factors were in play such as high blood pressure and anemia – both which she had to varying degrees in her adult life. (Of course, at her exam four days before her death, her blood pressure and iron levels were normal.)
Anita had a higher than normal pain tolerance and she had recently “given up complaining”, even to me. When she woke up at 4 am, she was in a lot of pain (I could tell) but she didn’t tell me what type of pain. Was this the placental abruption, or the beginning of it? I think so. Sometime between 4 am and 7 am, the combination of abruption and enlarged heart caused too much stress on her heart and it stopped.
I don’t know what to say. I’m so sorry.
Wow–this is hard, but I think that it in some sense helps–me, at least… It somehow makes it a bit easier to accept because there’s a “porque”, as they say in Spanish–there’s a “because.” And that “porque” was her heart–ironically one of the most expansive hearts we’ve ever known. It doesn’t make things better or take anything back, but in some sense it allows me to say, well there was something tangible that caused her death and that’s more concrete. I hope this brings some measure of peace, if not any lessening of the pain. We’re always thinking about you four and send you our love!
I hope knowing the cause will help you heal and bring you some sort of closure. I think Sarah VDP said it best….
Thank you for sharing. I think this helps all who knew her in some small way. Also, perhaps, more information to warn people about who are pregnant. So sorry. As always, prayers are with you and the children as nothing really takes away the pain. We are always here to read your posts and share your burdens. Blessings.
I am truly sorry about her death. I knew that it had to be something that could not be easily explained because Anita was so vibrant and full of life. She is and will be missed by us all. I commend you on your strength in being able to let us know what really happened to her. I know that was difficult to do. All my blessings.
All of the others have said it…all. Knowing really doesn’t make you less tired physically, but perhaps mentally and spiritually you have found some solace. We all love you.
The Lord bless you and keep you;
the lord make his face shine upon you
and be gracious to you; the lord turn his
face toward you and give you peace.
Numbers 6:24-26
(This is your dad’s favorite passage)
I’m sorry, I’ve taken so long to get back to you Greg, I have had to take some time to digest this. I can’t begin to say how sorry I am. I still struggle with the “Why God”.
I had a “gut feeling” this placental abruption was a possiblity. Just something I kept mulling over in the months following Anita’s death.
The only relief in knowing the cause is to put a label on it and to know for your girls health in the future. I am truly sorry, Greg. I wish I could go back in time and call her again or hear her laugh, selfish… I know. I pray for you and your beautiful family every night. You are loved from Nebraska and from the classmates of a much beloved girl with an infectious laugh and beautiful smile. She was everybody’s friend and made us all better people by gracing us with her presence in our lives, even if for a brief time.
God Bless you and I wish you peace!
Greg, It has taken me so long to write this…I wanted to write the first day I read it but I couldn’t bring myself to. I hope this brings you some closure. I know it doesn’t lessen your pain, but at least now we have a reason. I kind of suspected it was related to the pregnancy but wasn’t certain. I think of her often, miss her often, and see her in your children’s faces. She lives in my heart and head always. Wishing your beautiful family all the peace and healing in the world.
Greg, thank you for sharing this information. I realize that there is a disconnect between a reaching a medical conclusion and feeling emotional closure. As I read your update, I kept thinking about Anita’s bright eyes and her wonderful smile. I hope you and your family are okay.