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Anna’s final cause of death was ischemic stroke and heart attack. Anna’s sickle cell anemia resulted in reduced oxygenated blood flow throughout her body including her brain. Her familial hypercholesterolemia also largely contributed to her risk for heart attack and stroke and accounts for the plaquing (atherosclerosis) in her arteries and ischemia. Additionally, her lack of exercise and her diet high in carbohydrates did not help (and probably worsened) the symptoms she was already experiencing from her illnesses. When Lucy and Erica conspired to kill Anna, they switched her ceftazidime with ergotamine (migraine medication), it narrowed the blood vessels in her brain, and these conditions collectively lead to a stroke (from lack of oxygenated blood getting to the brain) and heart attack. When Anna experienced the stroke, she fell to the floor, hitting the table and knocking over the light. She began bleeding from this injury and also threw up due to the organ failure in her body. Her death at first seems natural due to the body system failure from stroke and then heart attack from built up blockage, but since Lucy and Erica conspired to murder her after she found out about their affair, the manner of death can be classified as homicide.

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*history of diabetes
*high calorie and fat diet
*stress

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*non smoker
*3 glasses of wine
*yoga

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Anna + Familial Hypercholesterolemia + Atherosclerosis

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Anna + Familial Hypercholesterolemia + Atherosclerosis

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-Anna is homozygous dominant for familial hypercholesterolemia
-this disease leads to atherosclerosis (buildup of plaque in veins and arteries) --> heart disease + heart problems

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-waist circumference = 35in (the most it should be)
-high blood pressure (140/70 mmHg)
-high cholesterol

Total Cholesterol – 389 mg/dL

LDL – 243 mg/dL

HDL – 60 mg/dL

-Higher than normal Triglycerides – 145 mg/dL

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-tachycardic – average resting heart rate ranged from 90-105 over the course of the day
-a few PVCs
-heart skips a beat
-ST elevation
-coronary artery disease due to blockage

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-left ventricular hypertrophy: thickening and enlargement of the heart’s walls in the left ventricle --> left ventricle is closing in, so the amount of blood that your blood can pump in one beat is reduced (causes low oxygen in the blood in the rest of the body and increased heart rate → increases stroke volume → overworks the heart → heart gets even more muscular (positive feedback loop)).
-irregular heart beat = uses pacemaker

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Anna Sickle Cell Anemia Genetics: Gel Electrophoresis

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Anna Sickle Cell Anemia Genetics: Gel Electrophoresis

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Anna Sickle Cell Anemia Genetics: Pedigree

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Anna Sickle Cell Anemia Genetics: Pedigree

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Anna was diagnosed with sickle cell anemia at 14 months old

running a fever, extremely lethargic, experiencing breathing problems, appeared to be in a lot of pain

Lower than normal hematocrit - 20% --> indicates Sickle Cell Anemia

Also found her spleen was enlarged with large amounts of blood inside it

taking Hydroxyurea to deal with it

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Anna was diagnosed with type one diabetes at age 14, when she was experiencing major fatigue and weight loss
-this means she needs to watch what she eats (which she doesn't do a very good job of)

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-lot's of soda
-chips and crackers
-low fat items (which actually have a lot of sugar and empty/bad calories in them)

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1 cup whole milk

1 biscuit

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Original Theories 1.1.2

1. The neighbor that claimed to have spoken to Anna Garcia earlier walked to her house with her, they got in a fight and he threw the lamp at her head and she fell over. Then he left and locked the door behind him.

2. Anna Garcia forgot to take her insulin and then had a heat stroke and fainted. She tried to grab the cart and knocked over a lamp and hit her head and bled to death.

3. Anna Garcia tripped and hit the lamp and fell and hit her head on the floor and died.

Modified/New Theories 1.1.3

1.  Alex Garcia murdered Anna Garcia in order to access the money from her life insurance in order to financially support him, his new wife, and his baby. Erica was spying on Anna Garcia the previous day.

2. (Modification of Theory 1) Doug and Anna got into a fight over their break up and he punched her and hit her head with a lamp so she fell on the table and died.

Modified/New Theories 1.1.4

1. Erica wanted the money from Anna’s life insurance to provide for her kids, as did Alex, so together they planned to murder Anna.

Modified/New Theories 1.1.6

1. Anna was standing and bleeding and then she fell over and bled from her head.

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The blood spatter of the size from the crime scene would be dropped from about 160 cm, indicating that Anna was standing up when she was bleeding.

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7:00 am

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The drug found at the crime scene was Acetylsalicylic Acid (aspirin).

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The shoeprint at the crime scene belonged to Anna Garcia because she has the same shoe size and shoe type as the shoe print found in her house.

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Fingerprints found at crime scene was the same type of fingerprint as Anna Garcia and Lucy Leffingwell.

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The hair at the crime scene belonged to Anna Garcia because the  cuticle, medulla, and cortex of Anna’s hair is the exact same as that of the hair found at the crime scene.

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Blood found at crime scene was the same type of blood as Anna Garcia and Erica Piedmont.

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Autopsy Reports + Possible Causes of Death

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Autopsy Reports + Possible Causes of Death

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1.3.1 Autopsy Report
Manner of Death: accident or natural (health problem)

Possible Causes of Death:

head injury = she probably fell and hit her head on the cart (fell on a solid object), hitting her elbow in her fall

Throw up suggests after hitting her head she was off balance and nauseous

loss of oxygen - she accidentally choked on something and lost oxygen, or her circulation was cut off, asthma?

injecting drugs

Choking on vomit

Internal bleeding

allergic reaction - injection on Anna Garcia

Suffocation - low oxygen levels (graying nails)

cardiovascular/respiratory problems = fingernail graying from lack of oxygen → heart failure

liver and kidney disease, cardiovascular diseases→ edema (can cause abdominal distension)

2.2.1 Autopsy Report
Possible Causes of Death:

lots of sugar/glucose (carbohydrates) in Anna's breakfast - spike in blood sugar and maintains this because type 1 diabetes

lipids/fat - consuming excess sugar causes glycogen (fat to build up) and consuming fat just adds to the fat so that it accumulates in the blood vessels since Anna Garcia doesn’t exercise → blood thickening → death

starches - long strings of simple sugars → glucose→  (fat free items, soda, complex carbohydrates) indicates diabetes → blood thickening → death

lack of proteins indicates an unhealthy and unbalanced die

high calorie foods such as whole milk and biscuits (Anna’s last meal) could have increased glycogen production because she is a type one diabetic - this could not only lead to obesity but it could also accumulate and clog her blood vessels leading to cardiac problems.

2.3.3 Autopsy Report
Possible Causes of Death:

ketones in urine = kidney disease/failure - due to diabetes or possibly a UTI

eye complications due to high blood pressure, as the blood vessels in both eyes are swollen and her right eye appears cloudy --> narrow blood vessels indicative of heart/cardiovascular system problems and failure

possible complications leading to death: Diabetic Ketoacidosis (DKA), eye complications, hypertension, oral health issues, cataracts, retinopathy, kidney disease/failure

3.3.1 Autopsy Report
Possible Causes of Death:

sickle cell anemia

lack of oxygenated blood to vital organs - some of which might already be damaged due to other illnesses/problems --> body system failures

lack of oxygen b/c anemic and sickle cell → heart problems → heart beats much faster - strain on heart = heart failure

4.1.2 Autopsy Report
Possible Causes of Death:

left ventricular hypertrophy --> left ventricle closing in --> less oxygenated blood pumped throughout body

mitral regurgitation b/c of left ventricular hypertrophy and blood moving back through the mitral valve

high blood pressure

diabetes

heart attack from 80% occlusion in coronary artery

stroke

high blood sugar - not enough blood flow to kidneys

high cholesterol → blockages in arteries

irregular heartbeat (uses a pacemaker)

5.15 Possible Causes of Death:

UTI = kidney failure/damage

UTI --> spread of infection through bloodstream causing organ failures/damage//weakened immune system

6.1.2 Autopsy Report
Manner of Death: Natural
Possible Causes of Death:

Heart Attack resulted from plaquing in arteries and ischemia and blood clot in the left ventricle meaning that the heart wasn’t contracting properly

Stroke resulted from ischemia and plaquing in arteries/occlusion away from the heart towards the brain. Necrotic brain cells due to lack of oxygen flowing through blood stream towards brain led to stroke (consistent with ischemia)

6.1.2 POLICE UPDATE
Manner of Death: homicide
Possible Causes of Death:

Erica and Lucy plotted to kill Anna after she discovered their affair by swapping her UTI medicine with migraine medication which further narrowed the blood vessels in Anna's brain leading to a lack of oxygen --> ischemic stroke --> heart attack --> organ failure --> kidney failure especially due to UTI

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-Anna's neighbor and friend
-Anna broke up with Doug abruptly in the past week
-last saw Anna at 6:30am
-says that Anna has been skipping her morning walk recently and she is very lonely
-called the police about Anna’s death

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-beneficiary to Anna's life insurance
-has financial problems
-married to Anna but then divorced her (nasty divorce)
-remarried quickly to his new wife, who is expecting a baby

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-Anna’s best friend and co owner of bakery with Anna
-Recently has been arguing with Anna - Lucy wants a sugar free line of products

-Has been debating whether or not to buy Anna out

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-new wife of Alex Garcia
-pregnant
-was seen sitting in car in front of Anna’s house the day before Anna was found dead
-has been arguing with Alex at dinner recently

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-Brown Hair
-Shoe Size: 7.5
-Owns a dog
-Was on pain meds after being in the hospital
-38 years old
-Hispanic

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Evidence #1 Anna Garcia’s body -on the floor near the front entrance of the house
Evidence #2 vomit- on the floor
Evidence #3 lamp - knocked over on the floor
Evidence #4 wheeling table
Evidence #5 hair
Evidence #6 shoe print
Evidence #7 cup
Evidence #8 syringe
Evidence #9 +#10 blood pools and blood splatters
Evidence  #11 insulin
Evidence #12 pills

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On the day that Anna Garcia died, she walked her dog at 6:30 am. She was wearing a sweater during a heat wave. Then, after Anna got home, her dog was barking for 2 hours (even though the neighborhood is typically quiet). During that time, Anna Garcia did not answer her telephone or her doorbell. She was found lying face down in the entry hallway of her home. At this time it was 73 degrees in her house.