Michael Jackson's Shocking Death: 'A Third of People Who Have a Heart Attack Actually Never Make It to a Hospital'

It appears that Michael Jackson died of cardiac arrest.

The Los Angeles Times is reporting that paramedics were called to Jackson's rented Holmby Hills home after a call to 911 reported a man who was not breathing, and that he later died of massive cardiac arrest. Paramedics at the scene performed CPR, but they may have arrived too late. According to Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, the window of opportunity emergency technicians have to revive those who suffer from a cardiac arrest is dangerously small—that is, assuming cardiac arrest was to blame. We asked Nissen, who has not treated Jackson, what could have precipitated Jackson's sudden, shocking death.

Some sources are citing cardiac arrest as the cause of Michael Jackson's death.
There are several types of arrest, though the most common is certainly cardiac. It is very, very common. A fact that many people don't know is that about a third of people who have a heart attack actually never make it to a hospital.

We do a great job of saving those that we actually get to a hospital alive. But many of them die outside the hospital. You have to get to the patient with a defibrillator within about four minutes to get a good outcome. [The Los Angeles Times reports that Jackson lived about six minutes from the hospital.] Between four and eight minutes things are a little bit questionable, and after eight minutes very, very few people will survive. And that's why defibrillators have been put in airports and so many public places. Generally, you can't get a paramedic crew to someone who is down that quickly. If you do good CPR, you can often extend that period some, but it's still a problem of needing advanced life support—meaning paramedics with defibrillators, drugs, and so on—really within a few minutes or the outcome is generally not very good, which is what it sounds like it wasn't here.

Some people who have a sudden event like that will have something other than a cardiac arrest; they'll have a brain aneurysm that burst. We had a congresswoman here in Cleveland, a very wonderful person, Stephanie Tubbs Jones, and that happened to her at age 50 or so. He is in the age group when sudden cardiac death is not uncommon. It's tragic. We've seen this with other celebrities. It's not anything different from what happened to Tim Russert or any one of a number of other people, and it's always a terrible tragedy when a person who is this young dies of a cardiac cause.

When the event is something other than cardiac, is it apparent to the paramedics?
It's generally not. Often you don't even know about it unless you do an autopsy. Because all you know when you get there is that the patient's heart is not beating, but keep in mind that there are other reasons. Sudden cardiac death—as opposed to sudden death—sudden cardiac death is overwhelmingly the largest cause. We assume that any sudden death like this is cardiac unless it's proven otherwise.

What are the risk factors? He's in the age range, but it does seem like the younger end of the age range.
We see people like this in their 30s, 40s, and 50s. It's more common in older people, but it certainly happens in people in this age group. The risk factors are the risk factors for heart disease: smoking, diabetes, high blood pressure, high cholesterol, all the things we talk about incessantly. Of course, whether he had any of these things, it's certainly an issue. Another thing that often comes up when a celebrity dies suddenly is a potential for drug use. That has happened in other famous cases: you may remember the basketball player Len Bias; first time in his life he ever used cocaine and he died suddenly. Again, I'm not saying that that's a likely prospect here, but I'm just telling you how we tend to think about patients like this when we see them.

There's a lot of speculation, and while you can't speak to this case directly, I was hoping you could help us separate fact from fiction. He was working out pretty heavily with a trainer [Lou Ferrigno]. Can excessive training lead to cardiac arrest?
That's just false. It's not a common cause.

People are saying that he's had a lot of surgery and been under a lot of anesthesia. Can repeated surgeries put you at risk for cardiac arrest?
That's nonsense.

He's African-American. Is that a risk factor in and of itself, or is just that African-Americans are more likely to have poor health care and poorer diets?
Generally, that's a reflection of socio-economic status, and he clearly had the resources to have good health care, He certainly wouldn't have been underprivileged in that sense, so I don't think it's a factor. The only factor that is important is that high blood pressure is genetically more common in African-Americans.

Is it possible to have a clean bill of health and still be at risk?
Absolutely. Every cardiologist I know has seen a patient in their office, done a complete examination, had a nice chat with them, given them all the reassurance possible that they were doing fine, then a week, a month later had this happen. There is no way you can predict these things.

Michael Jackson's Shocking Death: 'A Third of People Who Have a Heart Attack Actually Never Make It to a Hospital' | News