A pensioner who was treated for a heart attack after falling on her face was later found to be suffering from massive internal bleeding.

Esther Williams, aged 79, was given anti-coagulating medication which was then stopped when the seriousness of her condition was realized.

At an inquest in Ruthin John Gittins, coroner for North Wales East and Central, recorded a conclusion of accidental death as it was the fall which been the catalyst for the conditions which directly caused her death.

Mrs Williams, a farmer’s wife, of Highlands Road, Rhuddlan, was taken to Glan Clwyd Hospital after the fall on October 23, 2016, and transferred to the University Hospital, Aintree, six days later, but died on November 20.

Her daughter, Dr Ruth Craven, said she was an active lady but had been complaining of tightness in her chest and breathing difficulty, even though tests had shown no heart abnormalities.

Mr Gittins said he was aware of the family’s concerns about the incorrect diagnosis at Glan Clwyd, the multiple blood transfusions she received, and the impact of palliative injections at Aintree, when it was felt that her condition was terminal.

Pathologist Dr Timothy Halliwell, who carried out a post-mortem examination on Mrs Williams, gave the cause of death as haemorrhage due to traumatic rupture of the liver, but after hearing evidence from doctors from Glan Clwyd and Aintree the coroner said it was unclear exactly how the rupture had occurred.

After she was initially treated for a heart attack, based on the symptoms she had displayed, it was found that a cyst on the liver, first spotted in 1998, had grown to such an extent that it was affecting her lungs.

Asked by the coroner whether , with the benefit of hindsight, the abdominal problems should have been picked sooner, consultant gastro-enterologist Dr Aram Baghomian replied: “I don’t think so. The chest X-ray would not have identified the liver problem.”

Professor Graham Poston, from the Aintree hospital, who had been consulted by phone, agreed that Mrs Williams’ treatment was appropriate for the symptoms she had displayed on admission to Glan Clwyd.

Though Mrs Williams was very ill she eventually improved enough to be transferred to Liverpool, where her condition fluctuated. Though the cyst was believed to be benign the prognosis was poor.

“We considered what we could do to reduce the pressure inside the abdomen but surgery was risky,” said Dr Trystan Cole

Ward matron Jane Williams told the inquest: “Her decline happened quickly and she died sooner than we expected.”

The coroner recorded the terminal event as respiratory failure, with hepatic haemorrhage as a contributory factor, but added: “There is no doubt the catalyst for all that developed subsequently was the fall."

He said he did not think he needed to issue a Regulation 28 report to prevent future deaths, adding: “There are always lessons to be learned.”