Saturday, June 27, 2009

Please DON'T Call Cardiac Arrest A Cause of Death (2)

Cardiac_Arrest_by_SuperKusoKao[Continued from here]

More about the cardiac arrest business.

When I say it's silly to say someone "died of cardiac arrest", I am not saying that it's *wrong* - in fact it's absolutely true that a lot of people die when their heart stops. What I am saying instead is that calling cardiac arrest "the cause of death" is quite meaningless. It's almost like asking "Why was TDM hospitalised?" only to hear the answer of "The doctor asked him to stay". Absolutely accurate, but absolutely not answering the question too. I want to hear what illness he had that made him stay in the hospital; not whether the doctor, the surgeon or the physiotherapist asked him to.

It's technically correct to say someone died of stopping of the heart, but we shouldn't call it "THE cause of death" without knowing what caused the heart to stop in the first place. Cardiac arrest, or "the stopping of the heart", can be due to thousands of reasons.

  • Being immersed under the arctic ice cap for one hour.
  • Being electrocuted.
  • Dumping shit load of potassium ion into one's circulation.
  • Being born with a heart with screwed-up wiring.
  • Being born with thickening of certain parts of the heart (how many young athletes have sudden death).
  • Getting overdosed on drugs (which is currently one of the top hypothesis in MJ's case because he has been getting opioids from his doctor).
  • Having a massive heart attack.
  • Having a sick heart from a previous heart attack.
  • Having a huge clot in the pulmonary aorta.
  • And the list goes on.

In fact, almost any disease process or injury would kill you by stopping the heart in the end, with the exception of brain death due to brain injury. In brain death, even though their heart might still be beating, we also consider them dead because there is no longer a person in that body.


What about calling it a heart attack, some might say. THIS is another peeve of mine in the whole media report. Yesterday all the Fairfax newspapers in Australia reported that MJ has died from a heart attack when the official sources said NOTHING about a heart attack. It appeared to me that the Fairfax journalists have equated a cardiac arrest with a heart attack, which is to me as atrocious as equating bacteria to virus.

And NOW you see why I am so worked up.

Heart attack is a specific entity, and we say someone's got heart attack when his coronary arteries (which are the arteries that supply the heart itself) got blocked off by clots. Heart attack can cause death, and when someone dies in a heart attack they often die via cardiac arrest (i.e. when their heart finally stops). But in the process a lot of things could happen, their heart wiring may run amok, their heart walls may rupture, their heart will beat out of synchrony. And so on. And all that could be the precipitant for the eventual cardiac arrest.

In MJ's case, the current official word is cardiac arrest, and no official word has said he's got a heart attack. But I can see that some Australian media has automatically translated cardiac arrest to heart attack, which is quite misleading. In the early hours BBC also used the word "heart failure", which was also another term with a specific meaning in medicine.

It's probably the public health educator's fault that many people are unable to tell the difference between a heart attack and a cardiac arrest. The difference might not be that crucial for laymen, you might argue, and you are probably right. However, in the case of journalism, I don't think it's acceptable for a journalist to substitute "cardiac arrest" with "heart attack" without any verification and disseminate the information to millions of people. This is a count of irresponsibility.

[Continued here]


Casper said...

I am thinking that they might not know the real cause of the cardiac arrest. That's why they cite only cardiac arrest as cause of death

Andy Yijing Tan said...

STAR: Michael Jackson death still unsolved after autopsy

jinxiang said...

Here comes another great piece from you :)
I'm deceived by Kwong Wah newspaper too, it attributes his death to 突发心脏病 (heart attack). I do hope to know which specific cause it is.
Maybe it has something to do with his extreme and long-lasting life pressure? :D

solcroft said...

Still don't quite agree with you on the reasoning. It's not redundant IMHO, as there are plenty of ways people can die - asphyxiation, massive physical trauma, toxins, et cetera.

I do believe, however, that it does not provide sufficient information for the analytical individual, which may be why you're annoyed with it. :)

changyang1230 said...

Casper: Yup it's true that they haven't found the cause. The thing I am annoyed about is that the newspapers are treating cardiac arrest as a kind of distinct illness / condition just like heart attack, infection, cancer etc when it is not. A much better way to put it at this stage is "MJ was found to be at cardiac arrest due to unknown cause, and was unable to be resuscitated", not "MJ died due to cardiac arrest" and leave it like that.

Yi Jing: Thanks for the link! I am surprised that you still read my blog. :)

Jin Xiang: Ya all the Malaysian Chinese newspapers are calling it a heart attack too without a definite proof. Right now the doctors and family members are thinking it has something to do with a morphine-like medication that he's taking that caused his breathing to stop which then killed him.

Solcroft: I didn't call it "redundant", I called it "not answering the question". In fact your comment is precisely the same as my reasoning. Those things that you mentioned - asphyxiation, toxins, physical trauma etc ALL lead to cardiac arrest and THEN death. IN other words, toxins etc can all be added to my long list of causes of cardiac arrest.

The heart rarely stops without any reason at all. Yes sometimes we could never found a cause for a cardiac arrest, in which case we are forced to call it "THE" cause of death in the end, but this is never a good answer without first doing a thorough investigation. And in those cases, the cause is usually some sort of arrhythmia.