Student misdiagnosed with anxiety dies of rare hidden heart condition

Mariona Garcia Ramon

A student who had been diagnosed with anxiety collapsed and died of an exceptionally rare heart condition just hours later, an inquest heard.

In the days before she died, Mariona Garcia Ramon had been examined by two different medics who both put her shortness of breath down to anxiety.

But post-mortem tests revealed that although the 26-year-old was otherwise in the peak of health, one of her three heart arteries was blocked, which had caused the breathlessness and eventually triggered her collapse.

The inquest at Brighton and Hove Coroner’s Court, at Woodvale, heard how her boyfriend, Norbert Bare, had run back home after their flatmate called him to say Mariona was unconscious and was performing CPR on her when the paramedics arrived.

They rushed her from their home in Hereford House in Kemp Town to the Royal Sussex County Hospital where doctors tried to revive her for more than an hour.

But at 1.20pm on May 2, she was pronounced dead.

Pathologist Dr Mark Howard, who carried out the autopsy, said he had been very surprised to find the blockage in her artery. He said this would probably have caused her breathlessness because blood unable to get through would have started to fill her lungs.

He said: “She was incredibly fit and healthy apart from one blockage so she would have been able to compensate. It would have hidden the acute signs to a degree.

“There were periods where her heart function returned and cleared the congestion in her lungs.

“She was just incredibly unlucky to develop the fatty plaque where she did at such a young age.”

He said that although breathlessness could be a symptom of cardiac problems, it was also an indicator of many other conditions, and there was nothing in Mariona’s history, such as drug use, family history or other symptoms, to suggest a cardiac diagnosis.

And to illustrate how rare this would be, he said of the 5,751 female patients treated by the Sussex Cardiac Centre since it opened in 1999, only one woman under the age of 30 had suffered a heart attack.

Dr Howard added: “I wish I could give a reason why it has happened but there’s no reason in pathological terms. It’s both unbelievably rare and unbelievably unlucky.”

A couple of days before, on April 30, Mariona had called Norbert from the Walkabout in West Street where she worked asking him to pick her up as she was feeling unwell.

Norbert insisted she come with him to the walk in surgery at the top of Queen’s Road – a short walk, but one she could not manage without several breathing stops.

At reception, she checked the box to say she had chest pain which prompted nurse practitioner Charlotte Walsh to see her straight away.

But when she asked Mariona to explain, the Spanish student told her the pain was not in her chest, but her throat, and felt like something was stuck there.

Miss Walsh examined her throat for lumps and swelling and did not find anything, and her blood pressure, breathing and heart beat were all taken and found to be normal. She told her it was probably a physical manifestation of anxiety, but that she should get it checked out with her GP and to call 999 if the symptoms worsened and she could not breathe.

That night, Mariona woke up again feeling as though something was stuck in her throat and she couldn’t breathe. Her boyfriend Norbert Bare told the inquest: “She couldn’t understand what was going on. She was just looking at me and she couldn’t understand it.

“It took a couple of minutes and she just got better.”

The following day, Mariona went to Pavilion Surgery, where she was seen by Dr Catherine Burgess. Dr Burgess spent 26 minutes taking a “careful” history and then talking her through treatments for what she also thought was probably anxiety.

She said: “I wasn’t suspecting at all that she had a cardiac condition. I was very careful taking the history because I wanted to try and work out what the cause of her symptoms were and if she needed any other tests, whether there was an underlying condition.”

Assistant coroner Catherine Palmer said: “It’s not surprising that it wasn’t identified in a woman of her age with no specific symptoms … there was nothing to indicate at that stage at all that there was a cardiac problem.

“This was an extremely rare event and it would have been extremely difficult in the circumstances to have identified it. Anxiety was an appropriate diagnosis.

“It wasn’t until post mortem at the real reason for the symptoms and collapse revealed itself.”

She recorded acute cardiac arrest, or a heart attack, as the cause of death and recorded a verdict of natural causes.