Sudden Cardiac Arrest: Something That Doesn’t Even Spare Icons of Popular Culture
Michael Garko, Ph.D.
Host of Let’s Talk Nutrition
Stunningly, on Thursday, June 25, 2009, at 2:26 p.m. Michael Jackson, the legendary King of Pop was pronounced dead at the Ronald Reagan UCLA Medical Center. The exact cause of death (i.e., why death occurred such as infectious disease, heart disease, dehydration, blunt trauma, drug overdose etc.) and manner of death (i.e., how death occurred such as natural, accidental, suicide, homicide, undetermined) have not yet been identified officially. However, the prevailing belief is that he suffered sudden cardiac arrest (SCA) while at his rented home. The 9-1-1 transcript between Michael Jackson’s personal physician, Dr. Conrad Murray, and the 9-1-1 emergency operator and descriptions of his condition in the ambulance and at the hospital would suggest strongly he experienced SCA.
Assuming Michael Jackson indeed suffered SCA, the unanswered question is, “What precipitated SCA in Michael Jackson?” Knowing the answer to this question would identify the cause of death. Until the findings from his autopsy, including results from toxicology tests and investigative findings from the Los Angeles Police Department, are made available to the public and media, it remains unclear what exactly gave rise to Michael Jackson experiencing SCA.
Tragically, only a very few people survive SCA. Approximately more than 95% of people suffering SCA die before reaching a hospital (American Heart Association, 2009a). Unfortunately, Michael Jackson’s irrefutable genius, his astounding music career over more than four decades, his incomparable contribution to popular culture in the 20th and 21st centuries and being crowned the King of Pop did not allow him to be included in that small percentage of people who survive and recover from SCA.
In this July, 2009, issue of Healthful Hints, readers will learn about what SCA is, its causes, risk factors, warning signs, along with emergency treatment for it. Focus will also be given to sudden cardiac death, the ultimate consequence of SCA.
What Is Sudden Cardiac Arrest?
SCA (also known as cardiac arrest and unexpected cardiac arrest) is when heart function ceases abruptly and without warning, most often leading to sudden death (also known as sudden cardiac death) (see American Heart Association, 2009a, National Heart, Lung and Blood Institute, 2009, Sudden Cardiac Arrest Association, 2009). When there is an abrupt loss of heart function, the brain and other organs of the body are unable to receive oxygenated, nutrient rich blood. Brain death and permanent death begin within 4-6 minutes once SCA occurs (American Heart Association, 2009a).
Electrical Problem vs. Plumbing Problem
Frequently, the phrase, “massive heart attack” is used incorrectly to refer to SCA. Using a home improvement metaphor, SCA is an electrical problem. A heart attack (myocardial infarction) is a plumbing problem. While it can be a cause for SCA, a heart attack refers to when there is an obstruction of a coronary artery usually by a blood clot, which blocks the flow of oxygen-rich blood to a portion of the heart muscle resulting in the death of or permanent to damage to the heart muscle. Hence, this is why a heart attack is referred to as a plumbing problem.
In contrast, SCA is an electrical problem in that there is a disruption of the flow of electrical impulses in the heart, causing an irregular heart rhythm (called an arrhythmia), which in turn causes the beating of the heart to stop suddenly. There are several different types of arrhythmia. For example, the electrical impulses of the heart can be too rapid (called ventricular tachycardia), which can disrupt or otherwise interfere with the heart’s ability to supply oxygen-rich blood to the brain and other organs. The electrical impulses can also be too slow (called bradycardia) to the extent that it causes SCA. They can also be chaotic (called ventricular fibrillation). Any of these types of arrhythmia can cause an irregular heart rhythm leading to SCA.
However, according to the American Heart Association (2009b), “most of the cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both” (p. 1). In a real sense, when SCA occurs the electrical system of the heart is short-circuited by an arrhythmia causing the heart to stop beating and pumping blood to the vital organs of the body, especially the brain.
Causes of Sudden Cardiac Arrest
Ventricular fibrillation (VF or v-fib) is cited as the most common reason for SCA (see National Heart, Lung and Blood Institute, 2009). With VF, the lower chambers of the heart (called ventricles) stop beating and just quiver rapidly and irregularly. Instead of there being a regular electrical activation of heart muscle contraction, the heart is beset with chaotic electrical activity, causing the ventricles to stop beating and to just quiver rapidly and erratically.
There are a number of underlying factors which can cause the heart to experience electrical problems (arrhythmias) leading to SCA. The most common underlying reason for SCA is coronary heart disease (CHD)/coronary artery disease (CAD) (American Heart Association, 2009b). A heart attack, often occurring from CHD, is the most common cause of VF. Other heart conditions leading to SCA include enlarged heart, valvular heart disease, congenital heart disease and electrophysiological abnormalities (Mayo Clinic, 2009).
In addition to heart related conditions, other factors leading to SCA include respiratory arrest, electrocution, drowning, choking, trauma, intense physical stress, major blood loss, severe lack of oxygen, imbalance of electrolytes, especially potassium and magnesium (see American Heart Association, 2009a; National Heart, Lung and Blood Institute, 2009).
Given that SCA is linked frequently with the underlying cause of CHD, many of the risk factors for CHD are, thus, also associated risk factors for SCA. These would include such factors as:
• A family history of CHD
• High blood pressure
• High cholesterol
• Sedentary lifestyle
• Excessive alcohol intake
Other factors increasing the risk for SCA include:
• A personal or family history of arrhythmias
• A personal or family history of SCA
• Previous heart attack
• Previous heart failure
• Drug abuse (see Mayo Clinic, 2009; National Heart, Lung and Blood Institute, 2009)
As mentioned, SCA strikes suddenly without warning. The classic signs of SCA include the sudden loss of responsiveness/consciousness (fainting), no signs of normal breathing and no heartbeat or pulse (see American Heart Association, 2009c).
Remember, brain death and permanent death begins to take place within 4-6 minutes after the occurrence of SCA. Thus, time is of the essence in the emergency treatment of SCA.
If the above mentioned warning signs of SCA, then immediate treatment with an automated external defibrillator (AED) is necessary. Defibrillation must be performed within minutes of SCA. If you are alone and the above mentioned warning signs are present, call 9-1-1, if available use the AED and perform CPR. If someone is with you, have that person call 9-1-1, use the AED and begin CPR right away. If an AED is not on the scene, it must be used as soon as it arrives (see American Heart Association, 2009a; American Heart Association, 2009c; National Heart, Lung and Blood Institute, 2009).
Sudden Cardiac Death
The ultimate consequence of SCA is sudden cardiac death (SCD). Sudden Cardiac Death (SCD) takes the lives of nearly 1,000 people a day in the United States. This rate of mortality is equivalent to one death every two minutes or two jumbo 747 jets crashing per day (Heart Rhythm Foundation, 2006; National Heart Attack Alert Program, 2001). SCD is the most pervasive lethal manifestation of cardiovascular disease (CVD).
Although all known diseases of the heart can cause an abrupt loss of heart function (i.e., SCA) resulting in SCD, the most common underlying cause of SCD is coronary heart disease (CHD). Approximately 90% of adult SCD victims suffer from two or more diseased coronary arteries clogged by atherosclerosis (American Heart Association, 2006a & 2006b).
Unfortunately, SCD is the first and only symptom of a cardiac victim’s unexpected death. There is such little warning that approximately 335,000 people die annually of CHD without having the opportunity to be admitted to a hospital or taken to an emergency room. This amounts to about half of all deaths attributable to CHD. The majority of these are sudden cardiac deaths caused by cardiac arrest (American Heart Association (2006b).
When it strikes, SCA spares very few people, not even Michael Jackson. SCD is the first and only symptom of a cardiac victim’s unexpected death from SCA. Dying unexpectedly from SCA dramatizes the importance of maintaining cardiovascular health and preventing CHD, the primary underlying cause of SCA.
It is recommended that readers visit www.letstalknutrition.com and examine my ten part Healthful Hints series on cardiovascular health. One of the prevailing themes running throughout the Healthful Hints series on cardiovascular health is that people must take personal responsibility for their health.
The series proposes three action steps people can take to assume personal responsibility for their cardiovascular health. It can help readers become informed about the risk factors associated with CHD and their individual level of risk for CHD. The Healthful Hints series on cardiovascular health is intended to assist health consumers in adopting a lifestyle that excludes smoking and includes a heart-healthy diet and regular physical activity. It is proposed in the series that people can take personal responsibility for their health by creating, along with the assistance of a healthcare professional, a Personal Prevention Program based on the state of their cardiovascular health and level of risk for CHD. Recommendations are presented in the cardiovascular series focusing on the three most important factors to promote cardiovascular health and prevent CHD: Smoking cessation, heart-healthy nutrition and regular physical activity.
Perhaps if Michael Jackson would have been more in touch with how to take charge of his health and would have been surrounded by healthcare professionals and others to assist him in that endeavor, he would be with us today and not a victim of SCA.
American Heart Association (n.d.). Cardiac arrest. Retrieved June 26, 2009a, from http://www.americanheart.org/presenter.jhtm?identifier=4481
American Heart Association (n.d.). Sudden cardiac death. Retrieved June 26, 2009b, from http://www.americanheart.org/presenter.jhtml?identifier=4741
American Heart Association (n.d.). Heart attack, stroke and cardiac arrest warning signs. Retrieved June 26,2009c, from http://www.americanheart.org/presenter.jhtml?identifier=3
American Heart Association (n.d.). About sudden death and cardiac arrest. Retrieved June 26, 2009d, from
Heart Rhythm Foundation (n.d.), Sudden cardiac arrest key facts. Retrieved June 26, 2009, from http://heartrhythmfoundation.org/facts/scd.asp
Mayo Clinic (n.d.). Sudden cardiac arrest. Retreived June 26, 2009 from http://www.mayoclinic.com/health/sudden-cardia-arrest/ds00764/dsection=causes.
National Heart, Lung and Blood Institute (n.d.). What is sudden cardiac arrest? Retrieved June 26, 2009 from http://www.nhlbi.nih.gov/health/dci/Diseases/scda/scda_whatis.html