| On June 25, 2009, Michael Jackson, well-known as | | | | (7) Unknown causes. Unfortunately, a lot of cases |
| the King of Pop, died of cardiac arrest. | | | | of SCA are put down to unknown causes, often |
| Cardiovascular disease (CVD) is the leading cause | | | | in young, healthy people with no apparent heart |
| of mortality in the U.S. and the majority of CVD | | | | disease or other risk factors. |
| deaths are attributable to Sudden Cardiac Arrest | | | | How can death from SCA be prevented? Not |
| (SCA) which claims more than 250,000 lives each | | | | easy, in fact, 95% of SCA cases are fatal. To |
| year. One person dies of SCA-related events | | | | have a chance of surviving, victims of SCA must |
| every two minutes. This is equivalent to more | | | | receive life-saving defibrillation within the first 4 to |
| 650 deaths each day. Each year, more people die | | | | 6 minutes of an attack, when brain and organ |
| from SCA than from breast cancer, lung cancer, | | | | damage start to occur. |
| stroke, or AIDS combined. 95% of SCA cases | | | | Following are ways to restart the heart during |
| are fatal and two-thirds of SCA events occur in | | | | SCA: |
| people without any previous indications of heart | | | | (1) Defibrillators. These are the so-called paddles |
| disease. | | | | applied to the chest to deliver an electric shock to |
| According to the American Heart Association | | | | make the heart beat again. Defibrillators are only |
| (AHA), SCA occurs when electrical impulses in the | | | | available in emergency services and hospitals and |
| heart become rapid or chaotic, which causes the | | | | can only be operated by medical professionals. |
| heart to suddenly stop beating. The blood supply | | | | (2) Automatic External Defibrillators (AEDs) are |
| to the rest of the body ceases and without the | | | | battery-operated portable defibrillators. Current |
| blood supply, the oxygen supply is also cut off, | | | | AEDs are designed to be operable by almost |
| resulting in tissue damage and death. Because of | | | | anybody, even without formal medical training. |
| its suddenness, cardiac arrest is also called sudden | | | | AEDs are now widely available in public places |
| death or sudden cardiac arrest (SCA) or sudden | | | | where crowds tend to gather. |
| cardiac death. | | | | (3) Implantable Cardioverter Defibrillators (ICDs) |
| Cardiac arrest is not a heart attack. It is a | | | | are implanted in patients who have a high risk for |
| widespread misconception that SCA is | | | | cardiac arrest from recurrent, sustained |
| synonymous to a heart attack. In order to | | | | ventricular tachycardia or fibrillation. An ICD |
| educate the public, the AHA and the Sudden | | | | automatically reacts to irregular rhythms of the |
| Cardiac Arrest Coalition (SCAC) are quick to point | | | | heart and applies an electrical jolt to restore |
| out the difference. A heart attack or myocardial | | | | normal heart rhythms. According to the SCAC, |
| infarction occurs when the arterial supply or | | | | ICDs are 98% effective at protecting those at |
| coronary arteries are compromised or blocked, | | | | risk for SCA, but only 35 percent of patients who |
| thus cutting off the blood supply to the heart. | | | | require this device have one. According to a New |
| And if allowed to continue will eventually lead to | | | | York Times article "in the last two years the |
| infarction or injury to the heart muscles. "The | | | | number of patients receiving defibrillators has |
| term "massive heart attack" is often wrongly | | | | actually declined, as more doctors and patients |
| used in the media to describe sudden death." The | | | | decide the risks and uncertainties the devices |
| SCAC has a beautiful analogy to explain to the | | | | pose may outweigh their potential benefits." More |
| general public: "If you think of your heart as a | | | | recently, the European Society of Cardiology |
| house - SCA would be a problem with the | | | | (ESC) issued a statement on driving restrictions |
| electricity; a heart attack would be a problem with | | | | for patients implanted with ICDs. |
| the plumbing." | | | | (4) Cardiopulmonary resuscitation (CPR) works by |
| Cardiac arrest is not heart failure. In cardiac arrest | | | | attempting to maintain the blood flow to the |
| the electrical failure of the heart is sudden and | | | | heart and the brain until more effective |
| unexpected, whereas heart failure is progressive | | | | defibrillation can be performed. About 80% of |
| but slow, thus allowing time for heart failure | | | | SCA cases happen at home, just like in the case |
| patients to eventually be considered as possible | | | | of Michael Jackson. Therefore, CPR needs to be |
| heart transplant candidates. | | | | performed by bystanders, family members, and |
| Some people are more at risk for SCA than | | | | people, even without medical training. |
| others. | | | | Unfortunately, only a third of out-of-hospital SCA |
| (1) SCA deaths are more common among | | | | victims receive bystander CPR and many die |
| women aged 35 to 44 years old compared to | | | | before the arrival of emergency services. |
| men of the same age. Women have also a less | | | | Immediate effective bystander CPR can double or |
| chance of recovering from SCA than men. | | | | even triple a victim's dismal survival chances. A |
| (2) African Americans have a much higher risk to | | | | 2008 survey by the AHA revealed that 80% of |
| suffer from SCA-related events than whites and | | | | respondents said they were willing and able to do |
| other ethnic groups. They also have less than a | | | | something to help if they witnessed a medical |
| 1% chance of surviving, much lower compared to | | | | emergency. However, only a few (12%-20%) are |
| the 5% survival chance in the general population. | | | | confident that they would know when it is |
| (3) Some underlying conditions especially heart | | | | appropriate to perform CPR or use an AED. |
| problems make people more susceptible to SCA | | | | So, what could have caused Michael Jackson's |
| than others. Yet, even healthy individuals without | | | | cardiac arrest? Some of the possible causes |
| any health problems may suffer from SCA. | | | | based on Jackson's personal and medical history |
| There many things that can cause the heart to | | | | (Source: heartwire) include: |
| stop abruptly. Most of the cardiac arrests that | | | | (1) Overdose of prescription medications. |
| lead to sudden death occur when the electrical | | | | Expectedly this is the most popular theory but |
| impulses in the diseased heart become rapid | | | | without a toxicology report, this remains |
| (ventricular tachycardia) or chaotic (ventricular | | | | speculative. It seems that Jackson was on |
| fibrillation) or both. This irregular heart rhythm | | | | prescription painkillers and two that may possibly |
| (arrhythmia) causes the heart to suddenly stop | | | | be implicated in his death are Demerol |
| beating. Some cardiac arrests are due to extreme | | | | (meperidine) and Oxycontin (oxycodone). Dr |
| slowing (bradycardia) of the heart. | | | | Douglas Zipes of Indiana University Medical School, |
| So what causes the electrical system of the | | | | Indianapolis tells heartwire: "It's really where I |
| heart to fail? | | | | would go, but it's all very speculative at this point. |
| (1) Cardiovascular disease. According to the AHA, | | | | We know that depending on the type of |
| in 90% of adult victims of sudden cardiac death, | | | | painkillers, they can depress respiration. The initial |
| two or more major coronary arteries are | | | | stories are that he gradually slowed his |
| narrowed by fatty buildups. Scarring from a prior | | | | respiratory rate and stopped breathing. That can |
| heart attack is found in two-thirds of victims. | | | | create hypoxia, which can produce ventricular |
| (2) Electric shock/electrocution. A strong electric | | | | fibrillation." The use of Diprivan for his insomnia has |
| shock, e.g. electrocution and lighting strikes can | | | | also been implicated. Without an official toxicology |
| cause the heart to stop. Conversely, it also takes | | | | report, all these however, remain as speculations. |
| an electric shock to restart the heart. | | | | (2) Complications from lupus. It is not a |
| (3) Respiratory arrest. When people cannot | | | | well-known fact, but Jackson seemed to have |
| breathe during to choking, suffocation, drowning, | | | | been suffering from lupus, an inflammatory |
| or injury, SCA can also occur. | | | | disease that can also affect the heart and lead to |
| (4) Strenuous physical activity. There are cases | | | | a heart block. |
| of athletes suddenly collapsing during training or | | | | (3) Other heart diseases. A heart attack has also |
| competitions. This may be caused by underlying | | | | been speculated but the singer did not have a |
| heart abnormalities. Adrenaline released during | | | | history of heart disease and no other heart |
| intense physical activity acts as a triggering | | | | conditions were detected during the most recent |
| mechanism for arrhythmia and sudden death. | | | | routine physical exam. |
| (5) Medications. Certain drugs, prescription or illegal, | | | | (4) Stress. It cannot be denied that Jackson was |
| can interfere with heart rhythms. When taken in | | | | under too much stress. He was having major |
| excessive amounts, certain medications can | | | | financial problems and he was busy preparing for |
| completely stop the heart. Some of these drugs | | | | an international concert tour about to start in two |
| are: performance-enhancing drugs used in sports, | | | | weeks. |
| prescription drugs for heart problems, pain, and | | | | It is without doubt that SCA is a major and |
| sleeping disorders especially insomnia, and illegal or | | | | deadly health concern. Advocacy groups including |
| "recreation" drugs. | | | | the American Heart Association and the Sudden |
| (6) Trauma. A strong sudden blow to the heart | | | | Cardiac Arrest Coalition are actively involved in |
| during sports competition for example, can cause | | | | bringing this issue to the forefront. There are |
| a condition called Commotio cordis that can trigger | | | | even those who advocate the routine placement |
| ventricular fibrillation and lead to SCA. An injury | | | | of AEDs in the homes of patients who are at high |
| that damages the heart can also lead to cardiac | | | | risk. |
| arrest. | | | | |