Paramedic died of arrhythmia, autopsy finds – Maryland

By Jay R. Thompson

An irregular heartbeat was responsible for the death of county paramedic and firefighter Brian Neville, according to the State Medical Examiner’s office, whose staff conducted Neville’s autopsy.

Neville, 32, was normally stationed at Fire Station 11 in Hillendale, but was filling in as the county Emergency Medical Services district supervisor at the Cockeysville fire station Oct. 15.

When colleagues arrived the next morning, they found Neville dead.

The autopsy was performed Oct. 16. Seven weeks after Neville’s death, the medical examiner’s office reported on Dec. 4  that “cardiac arrhythmia due to the bridging of left anterior descending artery” was the cause of death.

Dr. David Fowler, Maryland’s chief medical examiner, explained that the heart not only pumps blood but needs blood to operate the same as any other muscle.

Blood is delivered to the heart by several arteries, but the left anterior descending artery carries about 40 percent of that blood, Fowler said.

Usually the left anterior artery runs on the surface of the heart, but Neville’s artery was “bridging” or “tunneling,” meaning that it ran partially through the heart’s muscle tissue, Fowler said.

Having an artery that bridges through heart muscle tissue — myocardial tissue — is not rare, according to Dr. Stephen Pollock, a cardiologist at St. Joseph Medical Center in Towson.

In Neville’s case, the crucial artery was compressed by surrounding muscle, thus restricting blood flow and oxygen, damaging cells and disrupting electrical signals.

This can cause an arrhythmia, or abnormal heartbeat, that can be “benign,” Fowler said.

But in Neville’s case, the results were fatal.

As Fowler described it, “heart function decreases and the brain becomes short of oxygen,” which leads to hypoxia, a seizure-like reaction that Fowler called a “terminal event.”

Fowler said it was not unusual to see bridging and tunneling in people Neville’s age.

He was a diabetic and wore an insulin pump, but that condition did not appear to play a part in his death, Fowler said. The forensic team examined the insulin pump and found nothing to suggest Neville had suffered a diabetic episode, he said.

The pump has been returned to the manufacturer for a final evaluation, however, and if the company were to discover anything that the team missed, the autopsy would be amended, Fowler said.