Q and A: What Carrie Fisher and George Michael can teach us about heart disease

by Staff report

Published Dec. 28, 2016, 8:59 a.m. ET

With the recent deaths of actress Carrie Fisher, 60, and singer George Michael, 53, of heart-related problems, we asked Benjamin Abella, M.D., director of the Center for Resuscitation Science at the University of Pennsylvania, a few questions about cardiac conditions, and what can be done to save people who suffer from them, including advice about CPR.

Check Up: Carrie Fisher's cause of death has been reported variously as heart attack and cardiac arrest. What's the difference?

Dr. Abella: Cardiac arrest is when the heart stops beating, abruptly and usually without warning. Cardiac arrest is 100 percent fatal unless immediate treatment is given, in the form of CPR and/or electrical defibrillation. A heart attack is when a coronary artery becomes blocked, leading to the death of a piece of heart muscle that was being nourished by that coronary artery. In a heart attack, the heart does not stop beating, and over 90 percent of people survive heart attacks, for which modern treatments include blood thinning medications and prompt angioplasty. Carrie Fisher had a cardiac arrest, it seems, not a heart attack.

On Christmas, 53-year-old singer George Michael, died of what his manager described as heart failure. Friends of his have said he appeared bloated recently. How is heart failure different from heart attack and cardiac arrest?

Swelling of the legs and elsewhere throughout the body could be suggestive of heart failure, but many other conditions as well. So it is possible he had heart failure, but it is hard to know without additional medical information. I suspect he also died of cardiac arrest. Heart failure is a slow and progressive condition in which the heart weakens over months to years, pumping less and less blood and leading to chronic symptoms of shortness of breath, weakness, and leg swelling. It isn't a sudden condition and usually it is well known to the patient and family that the condition is present.

News reports say that several days before her death, Carrie Fisher received first-aid from a fellow passenger on a flight, who was a paramedic. If she was indeed in cardiac arrest, how likely was it that the paramedic could have saved her?

Prompt CPR can double survival from cardiac arrest. For a case of witnessed cardiac arrest with good bystander CPR, the chance of survival ranges from 20 to 40 percent in many cases. Indeed, Carrie was initially "saved" by the paramedic -- her pulse was restored and she was very much alive. She died several days later, which is unfortunately common for many victims of cardiac arrest who initially survive but succumb to overwhelming brain and other organ injuries secondary to the arrest event.

Is it always better to attempt CPR in such an emergency, or can you do damage if you don't know the exact nature of the person's cardiac problem?

If someone is in cardiac arrest, it is always better to perform CPR. It is a required treatment, and it is not possible to hurt someone, in that if they are in cardiac arrest they will not survive without CPR. But CPR should only be given to a person who is unresponsive (that is, a person who appears unconscious). The vast majority of patients with heart attack are awake and talking; they should not receive CPR.

Carrie Fisher was 60 years old, which seems young for a cardiac death. Could this have happened without prior symptoms?

The median age for cardiac arrest in the US is around 62 years old, with the vast majority of arrests occurring in victims between 55 and 65 years old -- so she was a very typical age for this condition. And unfortunately, in most cases cardiac arrest occurs without warning. Risk factors for cardiac arrest are the same as for heart attack - because both have the same underlying cause of coronary disease, in most cases. So risk factors including smoking, high blood pressure, high cholesterol and family history of heart disease, for example.

Both Carrie Fisher and George Michael spoke of their struggles with drug abuse. Is that the most likely contributor to their deaths?

It is definitely true that drugs (especially opioids such as oxycodone, hydromorphone and heroin) can cause cardiac arrest since they cause people to stop breathing. In the case of George Michael and Carrie Fisher - I can't tell without more information. You can't assume that if a person with a history of drug abuse dies of cardiac arrest it's obviously because of the drugs. Hasty conclusions and making assumptions about sudden ailments are never good ideas.