Michael Jackson's Sudden Death–A Physician's Perspective

Mchael Jackson was rehearsing for his 50-concert tour on Tuesday night. Those present reportedly stated that they noticed nothing unusual. Less than 36 hours later he was dead.
The official statement so far is that he died of cardiac arrest. This just means that his heart stopped beating. The exact cause is either unknown or has not been made public. An autopsy is scheduled for today.

As with any sudden death, the departing of Michael Jackson leaves us with an incomplete feeling, along with the feeling of sadness. We ask: "How could this happen?" "Could it been prevented?"

Consider the very different reaction to the death of Farrah Fawcett on the same day. The actress was very open to the public about her battle with cancer. Her death was expected, and she died peacefully at home with loved ones at her side.

The official definition of sudden death is an unexpected death that occurs within one hour of the onset of symptoms. However, many sudden deaths are not witnessed. In those cases, we don't know if the person had any warning symptoms. This will likely be another unanswered question about Jackson's death.

Sudden death always surprises us. However, an estimated 20 percent of deaths in the United States each year are caused by cardiac arrest. This is when the heart abruptly stops pumping in an effective way.

Not all cardiac arrests result in death. However, the chance of survival after a cardiac arrest outside a hospital is only 5 percent.

Sudden cardiac arrest appears to strike like a bolt out of the blue, without warning. But this may not always be true.

A few years ago, researchers at the University of Berlin in Germany did some very thorough investigating of out-of-hospital cardiac arrests. They did extensive interviews with the paramedics, doctors and all of those who witnessed the cardiac arrests. The researchers found out that warning signs were surprisingly common in those cardiac arrests that had witnesses. The most common symptoms were:

• Chest pain
• Shortness of breath
• Dizziness
• Nausea or vomiting

Some people began to have these symptoms hours before the arrest. In 9 out of 10 cases, symptoms lasted for at least 5 minutes. Only 25 percent of the victims had true out-of-the- blue arrests with no prior symptoms.

The most common cause of sudden death in adults is heart disease, usually coronary artery disease. In fact, when someone dies suddenly you usually hear that "he had a heart attack," even if this is not the precise cause.

The term heart attack technically refers to a myocardial infarction. This is a type of heart-muscle damage. It occurs when a blood clot blocks one of the coronary arteries that feed oxygen and nutrients to heart cells. Some heart attacks damage just a small portion of the heart. Others are so severe that the heart can't pump effectively.

Even small heart attacks can cause cardiac arrest. The damaged heart muscle and nerve fibers close by become electrically unstable. They are prone to setting off a very fast and irregular heart rhythm called ventricular fibrillation. With this rhythm, the heart can't pump effectively.

Unless it is rapidly corrected, death occurs.

The best way to prevent sudden death is to prevent fatty build-up in your coronary arteries. This means choosing a healthy lifestyle, starting in childhood.

As an adult, you should know the factors that help to reduce your risk of for coronary artery disease, and act on them. They include:

• Not smoking
• Exercising regularly
• Eating more fruits, vegetables, whole grains and nuts
• Limiting saturated fats and avoiding trans fats
• Keeping blood pressure and cholesterol levels in the normal range, with medicine if needed

Don't ignore the warning signs. Chest pain is only one of several possible signs of an impending heart attack or sudden cardiac arrest. If you notice one or more of these signs in yourself or someone else, call 911 or your local emergency number right away:

• Uncomfortable pressure, squeezing, fullness, burning, tightness or pain in the center of the chest
• Pain, heaviness or other uncomfortable sensations in one or both arms, the back, neck, jaw or stomach
• Unexplained shortness of breath
• Sudden nausea or vomiting
• Feeling faint, especially while sweating heavily