Carrie Fisher’s sad, premature death is an occasion to reflect upon the poor job the news media does in reporting medical news. The initial report from TMZ had the headline “Carrie Fisher Massive Heart Attack on Plane.” If one equates “heart attack” to the more precise medical term “myocardial infarction,” as is usually done, then this is certainly diagnostic overreach on the part of TMZ. From their report it appears that Fisher suffered a cardiac arrest; indeed that term is used in the body of the article. So why not use that term in their headline? Perhaps massive heart attack sounds more dramatic. The word “massive” seems to go naturally with “heart attack.” Try to think of other phrases in which massive fits so well. Massive hack? Massive debt, perhaps? Few phrases roll off the tongue as well as “massive heart attack.” But most of the time when used by the media this phrase is not at all accurate. Rather it is a catch-all term to indicate something serious related to the heart has occurred.
Of course we don’t know exactly what happened to Carrie Fisher, nor is it any of our business, but none of the information available indicates that she had a large myocardial infarction as opposed to a primary arrhythmic event like ventricular fibrillation or ventricular tachycardia. As a cardiologist having seen this sort of event a depressingly large number of times it is possible to speculate on what happened. She likely suffered a cardiac arrest related to an abnormal heart rhythm starting suddenly in the heart’s ventricles. Lay persons and the media often refer to this as the heart “stopping.” While the pumping of the heart stops or is reduced, in actuality the heart is beating very fast or in a disorganized fashion to the point where it can’t effectively pump blood. Without rapid correction using an electrical defibrillator this leads to sudden death.
In Carrie Fisher’s case CPR was administered while the plane was still in flight. It is unclear how much time elapsed between the onset of the cardiac arrest and administration of CPR. It is difficult to tell from the reports if an AED was used on the plane or if defibrillation was attempted only after the plane landed. We know she never regained consciousness and most likely suffered brain death due to prolonged interrupted circulation.
Carrie Fisher was a cigarette smoker and used cocaine, at least during her Star Wars days. Could heart disease caused by smoking and drug use have contributed to her sudden death? Could more recent use of drugs like cocaine have been a factor? We don’t know, but if the family deems it fitting that the circumstances of her death be made public, it might help educate the public and the news media on some of the nuances of heart disease and the difference between a “massive heart attack” and a cardiac arrest.
Finally it is interesting to examine some of this lay cardiac terminology using Google Ngrams. The Google Ngram site is a search engine that can be used to look up the frequency of words or phrases in thousands of books published over many years. It can help establish when certain phrases like “heart attack” or “cardiac arrest” were first used and when they became popular. The Ngram at the top of this post of the phrase “massive heart attack” shows the rise in popularity of this phrase over the last 50 years. The Ngram below compares the terms “heart attack”, “myocardial infarction”, “sudden death”, and “cardiac arrest.” It is interesting that “sudden death” is a term that has been used without much change in frequency since the year 1800. “Myocardial infarction” and “cardiac arrest” both entered the literature around 1930-1940. “Heart attack” dates back to around 1920, but has become more and more popular, while the medical term, “myocardial infarction” seems to be less used recently. Curiously although the phrase “heart attack” has been around since the 1920s, it is only since 1960 that the phrase “massive heart attack” has become popular. One wonders why. These kinds of results are open to all kinds of interpretation: I’ll leave that to the reader as an exercise. But I encourage you to try Ngrams out yourself, on any subject that interests you. The results are often fascinating.
Another possibility after a long international flight is pulmonary embolism. It would be nice to know there was an AED on board and that the crew knew how to use it.
Absolutely to both points. It would make it even more misleading if the “massive heart attack” wasn’t even a primary cardiac event at all!
Thanks for a great post! These were my thoughts exactly when I read various reports and as Mike mentioned, PE seems like a distinct possibility. I did see a mention that she “was treated for a heart attack” when she arrived at the ER which makes me think it’s possible she did have an MI although details are lacking to conclude that with any certainty. If I were family I would want an autopsy. by the way when I wrote my song about clopidogrel , the opening line is ” I woke up this morning with a massive heart attack”. How would you feel about me re blogging this (of course with attribution) with some of my own comments on my site.?
Sure Anthony, you can reblog it. I think that to lay people “heart attack” means both cardiac arrest and MI, and has always meant that, as much as we’d like it to be used just for the latter. There’s a certain ring to “massive heart attack” that makes the phrase irresistible to headline writers and composers. By the way, I’m embarrassed to say my late father wrote a song entitled “Cancer is the Answer.”
You should definitely post your father’s song!