DEATH OF AN ICON : THE CARDIOLOGIST PERSPECTIVE

Undoubtedly, the most important headlines this week is the death of Michael Jackson. It was headlines news over all the newspapers, all over the world. On the 25th June 2009, Michael Jackson was pronounced dead at the University of California, Los Angeles Medical Center. He was said to have died from a cardiac arrest. That on its own, is not a proper cause of death. We are all anxiously waiting for the autopsy report. Well, what do the cardiac boys' say. It is common knowledge that MJ was under tremendous stress, with a 50 concerts due to start in about two weeks, he was to start an international tour to kick start his career again. He is USD400million in debt, he is 50years and have not performed for many years. He is high on drugs,including painkillers and occasional opiates. It is known that he was regularly on IV demerol, and also oxycontin. He was underweight when they did the autopsy, and allegedly quite emarciated.
What are the possible causes of a cardiac arrest? Or is it a cardiac arrest? His doctor, Dr Murray, was with in the house when he had the cardiac arrest. Dr Murray noted that he had a faint femoral pulse, when he arrived at the bedside. That would suggest that he may have been in respiratory failure, before the cardiac arrest. That raised the possibility of drug induced respiratory suppression as one would get with the opiates or other sedative group of drugs. IV Demerol could also cause hypotension, in someone dehydrated enough, to cause a hypotensive cardiac arrest. It is also interesting to note that MJ was under the care of a non-board certified cardiologist. Dr Murray is not board certified. Of course, Dr Murray tried to do CPR, but without opiate antagonist to reverse the opiate respiratory suppression ( if at all that is the cause ), and without endotracheal intubation, his CPR efforts would have been futile, as we now know it was. It was also alleged that Dr Murray performed the CPR without putting MJ on the hard floor. External cardiac massage would have been very ineffective, on the soft MJ bed.
Of course, he could have a cardiac arrest from other forms of drugs that he was taking. That is why we are awaiting the toxicology reports. With poor diet, and emarciated conditions, he may have been somewhat dehydrated, so that electrolyte imbalance and a cardiac arrest may have occurred.
It is also well know that MJ suffers from SLE. Lupus can also affect the heart, sometimes causing heart blocks, sometimes causing myocarditis and cardiac inflammation, thereby causing a cardiac arrest.
There is a distant possibility that at 50yrs, MJ could have had a heart attack, with that causing the cardiac arrest. MJ, though 50yrs old, never had a stress ECG? His cardiologist, Dr Murray felt that he looked well and so there was no need for a stress ECG, although all his concerts are heavily insured. Anyway it is important to note that a cardiac arrest is when the heart stops, either from ventricular fibrillation ( the heart fibrillating ) or complete heart block. A heart attack is when the patient has coronary artery disease ( maybe silent arteriosclerosis ) with atherosclerotic plaques on his coronary arteries. Should those plaque rupture, as it can do under severe stress, the resulting coronary thrombosis ( blood clot in the artery, blocking the artery ) causes the heart muscle cell death, we call a heart attack.
There is even a report that MJ may have committed suicide as his rehearsals were not going well. After not performing for so many years, and not being in perfect physical condition, he can hardly be expected to do the "moon walk ". Rather then face a flop on his comeback, he wanted to be remember for what he achieved earlier, not to mention the financial loss should the concerts flop. So he took his own life.
Whatever had happened, we would all have to await the whole autopsy report, including the toxicology report, before we can arrive at a definitive conclusion.
25th June has seen the death of an icon. May MJ rest in peace. His work on earth is done.