Common causes of cardiac arrest: high blood pressure, high cholesterol, stress and drugs

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Michael Jackson’s extensive plastic surgery and the vitiligo that produced his blotched skin almost certainly had nothing to do with the cardiac arrest that he suffered Thursday, according to experts who did not treat him.

The most common causes of this catastrophic event -- which affects at least a quarter-million Americans each year -- are high blood pressure, high cholesterol, smoking, stress or drugs. ‘That’s the equivalent of three 747s full of people crashing every day,’ said Dr. Douglas Zipes of Indiana University, a former president of the American College of Cardiology.

And an attack out of the blue is not uncommon, added Dr. Leslie Saxon, chief of the division of cardiovascular medicine at USC. ‘Often, sudden cardiac death is the first sign of heart disease,’ she said.

A cardiac arrest is a disruption of the electrical signals that trigger heartbeats, causing the heart to beat so erratically that it cannot pump blood effectively. The treatment is to use a defibrillator to shock the heart into normal rhythm, but that must be done very quickly -- typically within four minutes. ‘Without a defibrillator, you are going to die,’ Zipes said.

‘The problem and the tragedy is that [cardiac arrest] has to be witnessed for the patient to survive,’ and most are not, Saxon said. ‘Survival rates outside hospitals are less than 2%.’

Even in a hospital, cardiac arrests can be fatal unless the patient is hooked to an electrocardiograph, which can alert personnel. The highest survival rates for cardiac arrests are in casinos, where witnesses and defibrillators are common and personnel are trained to deal with such episodes. Airports are also good spots, for the same reasons.

Patients with known risk factors for arrhythmias, such as having had a previous heart attack, can be fitted with an implantable defibrillator that senses the cardiac arrest and jolts the patient back to life. Many such patients also have defibrillators in their homes, but these devices are less effective because they often aren’t used in time.

In the absence of a defibrillator, CPR can keep blood flowing to the heart and brain until paramedics can arrive with the device. But ‘you have to get to people very quickly if you are going to save them,’ said Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. ‘If it happens at home instead of in a public place, most paramedics can’t get to you that fast.’

In young people, such as athletes, the most common causes of cardiac arrest are thickened heart muscles and other congenital conditions that impair transmission of electrical signals. In older people, the causes are the same as for other coronary problems: high blood pressure, high cholesterol, smoking and stress. The most common cause of cardiac arrest is a blockage of an artery -- a heart attack. Less common causes include drug abuse and overdoses of some prescription medications, such as Demerol.

Even at Jackson’s relatively young age of 50, it is not uncommon for people to die suddenly from heart failure, even if they appear healthy, Nissen said. ‘I have patients that are thin, they are athletic, but their cholesterol levels are in the top 1% of the population,’ he said. ‘The fact that you’ve got a thin body and look like you are fit doesn’t mean you actually are.’

Jackson’s plastic surgeries almost certainly had nothing to do with his death. With any surgery, the patient can have a clot that can lead to a cardiac arrest, ‘but that is usually something that occurs within a reasonably short period of time after a surgical procedure,’ said Dr. Roberta Gartside, a plastic surgeon in Reston, Va., who is a vice president of the American Society of Plastic Surgeons.

‘There aren’t any surgical procedures that have a long-term potential complication that a patient might have a cardiac arrest,’ she said

It is equally unlikely that his vitiligo is involved. Vitiligo, in which patches of skin lose pigment, has an autoimmmune component that could potentially trigger cardiac arrest, ‘but usually autoimmune problems manifest in another way,’ Saxon said.

-- Thomas H. Maugh II and Karen Kaplan