What Does "ME" Mean on a Cause of Death Certificate?
"ME" on a cause of death certificate most likely stands for "Medical Examiner" rather than a medical diagnosis, as it refers to the certifying authority rather than a cause of death. However, if the context suggests a cardiac diagnosis, it could potentially represent "myocardial embolism" or be part of an abbreviation for myocardial infarction.
Understanding the Context
If "ME" Refers to Medical Examiner
- The Medical Examiner is the official who certifies the cause of death, particularly in cases involving sudden, unexpected, or suspicious deaths
- This is an administrative designation, not a medical diagnosis
- The actual cause of death would be listed separately on the certificate
If "ME" Represents a Cardiac Diagnosis
Myocardial Embolism as a Cause of Death:
Coronary embolism is a recognized but rare cause of myocardial infarction, accounting for approximately 5-13% of autopsy-studied infarcts, though this figure is likely underestimated 1, 2
Coronary embolism causes myocardial infarction through embolic material lodging in coronary arteries, leading to decreased myocardial blood flow and myocyte necrosis 3
Clinical Characteristics of Coronary Embolism
Common Underlying Conditions
- Valvular heart disease (40% of cases), particularly prosthetic mechanical valves, represents the most common predisposing condition 1, 4
- Atrial fibrillation (17-73% depending on the series) 5, 2
- Dilated cardiomyopathy (25-29%) 1, 2
- Infective endocarditis (22.4%) 5
- Prosthetic heart valve thrombosis (16.3%) 5
Anatomical Distribution
- Most emboli involve the left coronary artery and lodge distally, causing infarcts that are usually transmural despite the distal location 1
- The distal location and potential for recanalization may explain cases of myocardial infarction with angiographically normal coronaries 1
Classification Within MI Framework
Coronary embolism is classified as Type 2 myocardial infarction according to the American College of Cardiology and American Heart Association guidelines 3:
- Type 2 MI occurs when myocardial injury with necrosis results from conditions other than coronary artery disease contributing to an imbalance between myocardial oxygen supply and demand 3
- Coronary embolism is specifically listed as a mechanism of Type 2 MI 3
Clinical Presentation and Diagnosis
Presentation
- Initial presentation is indistinguishable from acute coronary syndrome due to coronary atherosclerosis, requiring high clinical suspicion 5
- Symptoms include chest discomfort, dyspnea, or other ischemic equivalents 3
- Average age of presentation is 54.2 ± 17.6 years 5
Diagnostic Criteria
- Diagnosis requires angiographic evaluation showing globular filling defects, saddle thrombi, or multiple filling defects with absence of atherosclerosis in coronary arteries (Shibata classification) 2
- Myocardial dysfunction on echocardiography is observed in over 80% of patients following coronary embolism 5
Associated Complications
Simultaneous systemic embolization occurs in approximately 25% of coronary embolism-related MI cases 2:
Prognosis and Outcomes
- "Good outcomes" are reported in 68.7% of cases, with a mortality rate of 12.9% 5
- Coronary embolism is associated with significant morbidity and mortality in the setting of acute MI 2
- Death from myocardial infarction due to coronary embolism occurred in 20% of autopsy-studied cases 1
Common Pitfalls
- Do not assume all myocardial infarctions are due to atherosclerotic disease; coronary embolism should be suspected in patients with predisposing cardiac conditions, particularly valvular disease, atrial fibrillation, or prosthetic valves 5, 1, 2
- In 26.3% of MI patients with coronary embolism, no identifiable cause is found, making diagnosis challenging 2
- The distal location of emboli may result in angiographically normal-appearing proximal coronary arteries, potentially leading to missed diagnoses 1