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One possible cause reported by celebrity website TMZ.com is that he was injected with the potent painkiller Demerol before he went into cardiac arrest.
Others speculate it was a combination of Demerol and Oxycontin, another powerful painkiller that is among the most commonly abused prescription drugs.
Here are some facts about cardiac arrest and both these drugs.
How could demerol cause cardiac arrest?
Cardiac arrest occurs when the heart stops circulating blood. In 80 percent of cases, the cause is heart disease, but narcotic painkillers like Demerol can cause cardiac arrest.
Dr. Daniel Simon, chief of cardiology at University Hospitals Case Medical Center in Cleveland, said if Jackson had been injected with too much Demerol, it might have caused him to stop breathing, a condition called respiratory arrest.
“The most likely scenario with Demerol would be that it caused a respiratory arrest because it takes away the drive to ventilate (breathe),” Simon said in a telephone interview.
He said low blood oxygen can trigger a deadly heart rhythm known as ventricular fibrillation in which the heart quivers but does not circulate blood. “Without CPR and a defibrillator, you have no chance,” Simon said.
Demerol and Oxycontin?
ABC News has reported that Jackson was addicted to prescription painkillers, and may have used Demerol in combination with Oxycontin.
Cleveland Clinic cardiologist Dr. Bruce Lindsay, past president of the Heart Rhythm Society, said the two drugs in combination could cause respiratory arrest.
“As with any of these painkillers, if you get too much on board, it really depresses the central nervous system so the patient could lapse into a deep sleep or even a coma. And if their respiratory capacity was too depressed, they would just stop breathing,” Lindsay said.
“If they stop breathing, eventually of course the heart will go into cardiac arrest, but not because of some primary heart problem. It is simply because the final mode of death is that the heart stops beating.”
Could it have been heart disease?
Simon said many media outlets are looking for exotic reasons to explain the singer’s death because it occurred in a relatively young man, but age 50 is not too young for sudden cardiac arrest.
“A lot of people are saying it’s a surprise a 50-year-old has cardiac arrest. Thirty percent of cardiac arrests are in people for whom it is their first symptom of heart disease,” Simon said.
“When they do an autopsy, the first thing the medical examiner will look for is a scar in the heart muscle suggesting an old heart attack,” Simon said.
He said 25 percent of patients who have cardiac arrest have had a prior heart attack without knowing it. “That is what the scar will tell them.”
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