Michael Jackson's coronaries acquitted

On June 25, 2009, newspaper and television headlines around the world screamed "cardiac arrest" as the King of Pop was rushed to University of California, Los Angeles medical center, apneic and pulseless. Talk-show hosts, news anchors, and bloggers weighed in, speculating on the etiology of his untimely demise. Physician commentators were asked repeatedly to discuss the causes of sudden cardiac death and prevention and treatment strategies. I sat in front of my television shaking my head in disbelief. I turned to my husband and said, "It doesn't fit his risk-factor profile. It wasn't a heart attack." I'm proud that theheart.org did not do extensive reporting on "the facts," because we did not have any. We merely reported what news we did have, as it was related to the public, as well as the speculation, and then patiently awaited the official results of his autopsy released just yesterday. 
 
Michael Jackson's heart had nothing to do with his death. 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. On a daily basis in every vascular practice, cardiologists and cardiology-care providers are asked to "risk-stratify" patients at a glance. Just based on what is apparent in the public eye, nothing pointed to atherosclerosis as a likely etiology, and there was far too much suspicion of wrongdoing to leave it at "sudden death."
 
For readers who are noncardiologists or even laypersons, let me quickly describe exactly how Michael Jackson's profile does not fit that of a typical young heart-attack victim. First of all, his mom and dad are walking around fairly healthy looking in their late 70s or early 80s. I've never heard of any of his many older siblings having had a heart attack, a coronary stent, or a bypass surgery. The greatest indicator that this probably wasn't high-grade fixed coronary atherosclerosis (or blockage) is that Michael Jackson was a skinny nonsmoker and he was rumored to be a vegetarian.  Despite the claims of debilitation, he looked thin from the other side of the television screen but not emaciated, and he could dance for long periods of time, although I did notice he did appear winded at the end of a performance, but then again, who wouldn't? (Caution here on the exercise-tolerance issue, as 30% of all heart attacks may be asymptomatic).  
 
As for sudden cardiac death, a term to describe a sudden fatal rhythm change, often utilized in a context without structural heart disease, anyone and everyone is at risk on a daily basis, at least from this vantage point in the early history of the human genome project. There are entities like long QT syndrome, Wolff-Parkinson-White syndrome, and hypertrophic cardiomyopathy as well as other undefined sudden-death harbingers, and there are risks, especially in middle-aged women, of sudden death without obvious cardiac difficulties, but in the grand scheme of things, in a 50-year-old male, they aren't high on the list of possibilities. By the time a cardiologist who treats adults sees someone with these entities, it's a replay of the only evolutionary principle I ever defend, "survival of the fittest." Adult patients with those entities have already survived with perhaps a "watered-down" version of some of the more malignant forms of the disease that cause young children and teenagers to die suddenly.
 
The term sudden cardiac death is also applied to the end result of a sudden plaque rupture, coronary thrombosis, vasospasm, or sudden coronary occlusion leading to a classic heart attack and then ventricular fibrillation. This is the ever-present possibility looming largely over Americans because of our undiagnosed or malattended diabetes, mild to moderate obesity, smoking, and sedentary lifestyle, none of which fit Michael Jackson. So, from his apparent risk-factor profile, I've defended Michael Jackson's heart from the very first moment of asystole. His coronaries stood accused when his brain was indeed the culprit, writhing with the demons of addiction that promised relief from emotional and physical pain but instead choked the life from his myocardium and stilled the beating heart of one of the most talented icons of all time. I bemoan the fact that "one of us," a cardiologist, allegedly aided and abetted his unnecessary death. If he's guilty, I regret that he deserves to spend a good long time confined in a place where he can sit and think about how he betrayed his noble profession for a fistful of dollars, a Judas to the world of cardiology. 
 
Despite his many faults, quirks, and weaknesses, I cannot help it. I loved Michael Jackson's music and I continue to love it today. I found a way to separate it from the weirdness, and even as I write this piece, I can hear his song "You are not alone" in the back of my mind. I don't know why it was so important for me to hold out for the truth and try to defend his coronaries so vehemently. I never even met him and I never once saw him in person, but I did want the truth to be the truth because somehow, I do think he would want his fate to be transformed into something that could help others. I think his love for his children and his family was pure, and I think he would want the entire world to know that his heart in more ways than one was innocent in the end.   

See:

Mainly medical unknowns regarding Michael Jackson's apparent cardiac arrest 

Michael Jackson dies of cardiac arrest 

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