Acute Myocardial Infarction
An Ada County Deputy Coroner received a call from Ada Dispatch regarding a 51 year-old male that had been found deceased at his residence by his housekeeper this morning when she came to clean.
Arriving on scene the Deputy was greeted by patrol officers who had initially responded to the call. According to the officer writing the report, the housekeeper stated that she had talked with the subject earlier in the morning at approximately 0800 she called and told him she was running a little late and would be there around 0930. He stated that he would be home as he had taken the day off work as he was not feeling well. He said that he had been up most of the night with nausea and heaviness in his chest. He thought he had a touch of food poisoning.
According to the housekeeper, she arrived at 0920, ran the doorbell and waited. When he did not respond to the door, she used her key to enter the residence. Entering the house she found the subject face down on the kitchen floor. She called his name but had no response. She immediately called 911 and EMS responded.
According to EMS, the subject was non-responsive and asystole (a state of no cardiac electrical activity) when they arrived. No medical intervention was initiated. They stated that the subject had a history of hypertension, diabetes and had stints placed two years previous.
The body was examined and was found to have no signs of foul play or trauma. It appears he collapsed as he was making toast in the kitchen. Toasted bread was seen in the toaster. The subject had purple cyanotic staining from his breast line up to the top of his head. His lividity was consistent with the position he was found.
The Deputy Coroner contacted the subject’s primary physician with information gathered and the doctor confirmed the history obtained my EMS. After review of medical records and details from the on-scene investigation, the physician stated that he would sign the death certificate with manner of death being natural and cause of death being an Acute Myocardial Infarction. The Deputy Coroner and the physician both conferred and stated that the “heaviness in his chest and nausea” and the cyanosis shown on the body were probably the result of a major cardiac event.
What is a "Myocardial Infarction"
This term refers to the death of a certain segment of the heart muscle (myocardium), usually the result of a focal complete blockage in one of the main coronary arteries or a branch thereof.
The main cause of myocardial infarction is atherosclerosis in the coronary arteries. This event results in impaired contractility of the heart muscle within seconds, and is initially restricted to the affected segment.
The myocardial ischemia or infarction begins in the endocardium (the inner lining of the heart) and spreads to the epicardium (the outer lining of the heart). Irreversible heart damage will occur if the blockage is complete for at least 15-20 minutes. Irreversible damage occurs maximally in the area at risk, and when the occlusion is maintained for 4-6 hours. Most of the damage occurs in the first 2-3 hours. Restoration of flow within the first 4-5 hours is associated with salvage of the heart muscle, but the salvage is greater if flow is restored in the first 1-2 hours. 
A major determinant of death and illness is the size of the infarct. Increasing the oxygen supply to the involved site of blockage by coronary reperfusion (angioplasty, stents, atherectomy) is more effective in salvaging the myocardium than decreasing oxygen demand.
A lack of oxygen supply to the heart leads to adverse clinical consequences such as angina, heart attack (myocardial infarction) and sudden cardiac death.