Michael Jackson’s death: Why it couldn’t have been a heart attack

October 5, 2009 by  
Filed under HEART AND STROKE

Michael_Jackson_1984When Michael Jackson suffered from cardiac arrest on June 25 this year, there were speculations that led to erroneous reports that Jackson suffered from a heart attack. It wasn’t clear whether the heart attack theories were based on medical evidence or the common mistake of equating cardiac arrest to heart attack. Once again, I have to put emphasis that heart attack (myocardial infarction in doctor speak) is not synonymous to (although it can cause) cardiac arrest, which is the sudden stopping of the heart.

Heart expert Dr. Melissa Walton-Shirley of Theheart.org wrote her blog heartfelt the many reasons why she is convinced that „Michael Jackson’s heart had nothing to do with his death [and] …was merely an innocent bystander.“ Dr. Walton-Shirley based her opinion on her analysis of Jackson’s risk factor profile which does not fit that of a young heart attack victim. These factors are listed and discussed below:

  • Family history. Heart disease seems to be not a part of the Jackson family medical history. Jackson’s parents are elderly (his mom is 79, his dad is 80) but are still fit. There has been no report of cardiovascular disease among his siblings.
  • Weight. Excess weight is a major risk factor for heart attack. Jackson was not overweight. On the contrary, he was underweight, looking „thin from the other side of the television screen but not emaciated.“ Excess weight is a strong indication of blocked arteries that lead to heart attack
  • Non-smoking. Smoking is another risk factor to consider and Jackson was a non-smoker.  
  • Diet. Jackson was rumored to be a vegetarian. Whether true or not, there is a strong indication due to his weight that he is not fond of animal fat.
  • Physical activity. The King of Pop can dance for extended periods, a feat that people with heart normally can do. Dr. Walton-Shirley, however, warns: Caution here on the exercise-tolerance issue, as 30% of all heart attacks may be asymptomatic.

In summary, Jackson did not have the most common risk factors that made him a likely victim of a heart attack.

Cardiac arrest, however, can be caused many things (including heart attack) and anybody can suffer from cardiac death that may or may not have to do with heart disease.

The latest autopsy reports reveal

Jackson was a fairly healthy 50-year-old before he died of an overdose. His 136 pounds were in the acceptable range for a 5-foot-9 man. His heart was strong with no sign of plaque build-up. And his kidneys and most other major organs were normal.

As to the real of cause of Jackson’s death, investigations are still ongoing. However, Dr. Walton-Shirley writes:

„His heart was merely an innocent bystander, a victim of the pop icon’s addiction and poor judgment, allegedly damned by a cardiologist’s stupidity, greed, and criminal negligence.“

Photo credit: wikicommons

Propofol: the doctors’ drug

September 2, 2009 by  
Filed under ADDICTION

syringeIs your doctor a junkie?

Everybody is suddenly talking about propofol. It’s the drug that killed Michael Jackson, right? The truth it, several substances have been found in Jackson’s system during the autopsy but propofol seems to be the most likely culprit. Just another unfortunate overdose story? Not really.

For one thing, there is more to this drug than just meet the eye.  Propofol is a commonly used anesthetic agent, used to initiate unconsciousness during surgeries. It is supposed to be fast-acting and safe. But medical professionals know better.

It is common knowledge among the medical circles that propofol  is addictive. It is also common knowledge that medical professionals, especially anesthesiologists are misusing and abusing propofol as a recreation drug.

Unbelievable, isn’t it? The very people who are supposed to prescribe and administer drugs are the ones who are most likely to abuse it. In an article in Men’s Health  last year, the question arose whether there is “a junkie in the OR.” And the answer was most likely yes. Anesthesiologists are especially prone to dependence on the drugs they handle. During surgery, these doctors are exposed to sedatives, anesthetics and other drugs, and propofol is just one of them.  One survey of 133 teaching hospitals revealed that ” faculty anesthesiologists and their anesthesiology residents were four times more likely to have had substance-abuse problems than other physicians.” It seems that drug exposure and abuse are an occupational hazard among anesthesiologists.

But here comes the most shocking of all: aside from “pilfering” and “stealing”, the hospital junkies are not really committing a crime when they shoot up propofol. You see, propofol is not a controlled drug, not considered to be a narcotic or addictive substance according to the Drug Enforcement Administration’s (DEA) current list of regulated drugs. While drugs as valium and codeine (found in cough syrups) are controlled and are place under certain “drug schedules”, propofol is not. Strange, isn’t it?

Controlled drugs are regulated in a lot of ways: distribution, storage, prescription, and inventory follow strict guidelines. Only certain medical professionals with special licenses are allowed to prescribe them. It is illegal to transport or carry these drugs across borders unless you have a special license. In other words, these are drugs that you just don’t leave lying around or carry in your pocket. In the case of propofol, no restrictions are in place. It is easily available and accessible to anybody working in a hospital or clinic. Really perfect for a recreation drug, isn’t it?

Michael  Jackson used propofol  as a sedative to go to sleep. Medical professional junkies just use it at subanesthetic levels to get “high” – described as a feeling of elation and sensitation. There have been previous cases of lethal overdose of propofol, including a murder case. A male nurse was found guilty of  murdering his girlfriend with propofol in 2008.

So what are the health authorities doing about this? The DEA is now under pressure and is considering to include propofol in the list of controlled drugs. It takes a lot of publicity, such as in the case of Jackson’s death, to change things for the better.

Controversy about Michael Jackson’s CPR and emergency care

August 31, 2009 by  
Filed under HEART AND STROKE

michael_jackson_1984Last week, the LA coroner’s office announced that they are treating the death of Michael Jackson as a homicide.

Apparently, lethal amounts of the anesthetic-sedative drug propofol and other drugs were found in Jackson’s body during autopsy. And Jackson’s personal physician Dr. Conrad Murray is the focus of the investigation.

Murray was also criticized about his delivery of emergency care to his celebrity patient. Here are some of the questions that have come up:

Did Murray perform CPR properly?

CPR, short for cardiopulmonary resuscitation is performed when a person suffers from cardiopulmonary/cardiac arrest, e.g. the victim stops breathing and/or the heart stops beating. (Possible causes of the cardiac arrest have been discussed in a previous post). CPR, which consists of rescue breathing and chest compressions, is applied immediately after collapse to keep the blood circulating to the brain while waiting for emergency services to arrive. Murray reportedly found Jackson in his bed with a weak pulse and immediately started CPR. Many people questioned the effectiveness of performing CPR chest compressions on a bed/mattress. It is recommended that CPR works best when a patient is lying on a hard, flat surface such as the floor. Should the doctor have moved Jackson to the floor before starting CPR?

Was there an AED in the house?

cpr_training-04CPR alone cannot restart the heart. It needs an electric shock from a defibrillator to make beat again and this has to be done within 7 minutes of collapse, even with CPR before permanent brain damage and death occurs. Without CPR, this window of opportunity becomes shorter. Portable defibrillators, called automated external defibrillators (AEDs) are easily available and can be used even by laypersons. Could an AED have saved Jackson’s life?

Why did it take so long for the doctor to call 911?

The survival rate among cardiac arrest victims is very low. Every second counts if death is to be prevented. CPR alone cannot save a life. An AED within public access or by emergency medical services (EMS) is needed within the shortest time possible to restart the heart and the blood supply to the brain. CPR can minimize brain damage and extend the window of opportunity to save the victim’s life until professional emergency help comes. Unfortunately, it is unclear when the cardiac arrest happened and when the 911 call was made. It also reportedly took 25 to 30 minutes between the 911 call and the arrival of the paramedics. By then it was too late to save the King of Pop. So the next question is:

Why did it take so long for the EMS to arrive?

Photo credits: wikicommons

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.