Michael Jackson's Death: Why Cardiac Arrest Is Deadlier Than Heart Attack



By Theresa Tamkins
THURSDAY, June 25, 2009 (Health.com) — Iconic pop star Michael Jackson suffered a cardiac arrest and died on Thursday at the age of 50. Details of his death are still emerging, but friends and relatives say they have been concerned about Jackson’s use of prescription painkillers.

Brian Oxman, the Jackson family spokesman and attorney, told CNN that people surrounding Jackson were “enabling” him in his use of medications. Jackson had suffered a number of injuries, including a broken vertebra and a broken leg sustained in a fall on stage, Oxman said.

“If you think the case of Anna Nicole Smith was an abuse, it is nothing in comparison to what we have seen taking place in Michael Jackson’s life,” Oxman told CNN.

“I do not know the extent of the medications that he was taking, but the reports that we have been receiving in the family is that it was extensive,” he said. “This is something which I feared and it is something that I warned about.”

Douglas Zipes, MD, a distinguished professor at the Indiana University Medical Center and past president of the American College of Cardiology, says that drug abuse can contribute to a cardiac arrest.

“Certainly drugs, in someone like Michael Jackson, have to considered,” he says. “We know that drugs like cocaine and amphetamines can trigger a cardiac arrest by themselves, and the summation of multiple drugs could ultimately result in a cardiac arrest.”

Jackson may have been underweight as well. He reportedly weighed 120 pounds in 2003. At 5’10” or 5’11” (reports vary), he would have had a body mass index of 16 or 17, and anything below 18.5 is considered underweight.

In recent months, friends and relatives had described Jackson as even more frail. Filmmaker Bryan Michael Stoller, who visited Jackson in April, told People, "I hugged him and it was like hugging bones.” And a fan who recently met Michael Jackson at a tour rehearsal reportedly wrote in an email this week, “He is a skeleton.”

Next page: Why weight loss can be dangerous

Extreme weight loss can cause electrolyte abnormalities, according to Dr. Zipes. “Two very important electrolytes, potassium and magnesium, are critically important in maintaining normal electrical activity of the heart,” he says. “[If] one or both electrolytes were very low, they can trigger cardiac arrest.”

Another factor that may have played a role is stress, says Dr. Zipes, who has not treated Jackson.

“He’s been under incredible emotional stress—the legal issues with the accusations of child molestation, the financial debt that he’s incurred, the prospect of a world tour after not performing for years; it would seem to be daunting,” he says. “All of these things would seem to be extremely stressful and stress certainly can play a role in the development of coronary disease and sudden death.”

In general, a cardiac arrest is much more dangerous than a heart attack.

During cardiac arrest, the heart actually stops beating and quivers with uncoordinated contractions. Unless a defibrillator is used to shock the heart back into a normal rhythm, death is inevitable. Someone experiencing a cardiac arrest generally collapses, loses consciousness, and stops breathing.

“[The heart] stops contracting effectively but it’s actually beating—if you take the word beating as an electrical event. The heart rate of the bottom chambers, the ventricles, is 400 to 600 times a minute—that’s ventricular fibrillation,” says Dr. Zipes. (The normal adult heart rate is 70 beats per minute.) “When it increases so dramatically it actually looks like a bag of squiggly worms—there’s no effective contraction.”

Despite dramatic TV portrayals of patients being revived from cardiac arrest, the chances of survival in real life are slim. If a bystander performs cardiopulmonary resuscitation until the heart can be shocked back into a normal rhythm, the chances of survival are much better.

About 95% of people who experience a cardiac arrest die before reaching the hospital. Overall, about 1,000 cardiac arrests occur each day in the United States; that's roughly 350,000 per year.

A heart attack, on the other hand, is a reduction in blood flow to the heart, which can cause a crushing chest pain known as angina, along with sweating, nausea, a sense of impending doom, and tissue death in part of the heart muscle. In contrast to cardiac arrest, heart attack patients may not lose consciousness. If they get rapid medical treatment, the prognosis is generally better. Heart attacks are about twice as common as cardiac arrests, but a heart attack can progress to a cardiac arrest if not treated.

Heart attacks are more common in those with heart disease, high blood pressure, obesity, and diabetes. (Read more about heart attacks.) Cardiac arrest, on the other hand, can be caused by a wide variety of factors, including heart disease, drowning, electrocution, choking, and traumatic injury.

The American Heart Association recommends that people know the warning signs of cardiac arrest (loss of consciousness, lack of pulse), call 911, and perform CPR until help arrives. Bystanders can even administer chest compressions alone and skip mouth-to-mouth breathing while waiting for emergency help or defibrillation, according to recent guidelines from the American Heart Association.

“I think it’s tragic whenever anybody has a sudden cardiac death, particularly somebody whom you would consider to be relatively young. I don’t think society considers that people in their 50s can die suddenly—I think that adds to the tragedy of the situation,” says Stephen Nicholls, MD, a cardiologist and assistant professor of molecular medicine at the Cleveland Clinic, in Ohio.

“The other thing it highlights is the importance of CPR and the importance of using defibrillators,” he says. There’s been a push in recent years to make sure automated defibrillators are in airports, shopping malls, and sports stadiums.

“The most prompt action to try to restore heart rhythm in that situation gives you the best chance of survival,” Dr. Nicholls says.

* Story updated 6/26/2009