By James Beckerman, MD, FACC
Today, our obsession with celebrity combined with a 24-hour news cycle afforded by the internet and cable television make any tragic event seem worthy of further investigation. Like many people, I hear about the deaths of celebrities and feel empty. And curious. Because much in the same way that we are fascinated by the road that people take to achieve success, we are similarly captivated by the choices people make that lead to tragedy. We can learn from people’s good choices, and conversely we can learn from others’ mistakes.
For instance, smoking cigarettes may lead to chronic lung disease, which can be treated with steroids, which may impact the immune system, which can increase the risk of pneumonia. Chronic breathing problems may limit our ability to exercise. Steroids may worsen diabetes. In our effort to simplify a final moment, we uncover people’s inherent complexity.
For Whitney Houston, it was no different. Her autopsy report identified a 60% blockage in her right coronary artery and no evidence of a blood clot in the vessel or a heart attack. Toxicology testing showed cocaine, benzoylecgonine, cocaethylene, marijuana, alprazolam (Xanax), cyclobenzaprine (Flexeril), and diphenhydramine (Benadryl) in her system.
Substance abuse, and cocaine in particular, carry significant risk of the development of heart disease. Cocaine can impact the heart in three ways. The first is that the increased heart rate and high sympathetic tone can increase the risk of developing a cardiomyopathy. This is characterized by reduction in heart function and can be associated with symptoms of congestive heart failure like shortness of breath, fatigue, and swelling in the legs and ankles. Cardiomyopathies can also be associated with abnormal or dangerous heart rhythms.
The second way that cocaine can impact the heart is by promoting early-onset coronary artery disease, though the mechanism is not well understood. While some younger women like Whitney Houston may develop coronary disease, it is not as common in the absence of other significant risk factors like diabetes, high blood pressure, or abnormal cholesterol. It is possible that cocaine use might have contributed to the 60% stenosis noted in her right coronary artery. Her autopsy would suggest that, despite having coronary artery disease, she did not have a heart attack. There was no evidence of a ruptured atherosclerotic plaque or a clot at the site of her blockage to suggest an abrupt closure of the vessel. Additionally, inspection of the heart itself did not indicate any obviously damaged muscle, although earlier in a heart attack this might be more difficult to detect.
Finally, the possibly most life-threatening cardiac manifestation of cocaine use is abnormal heart rhythms, or arrhythmias. Using cocaine increases the possibility of developing dangerous heart rhythms that arise from the ventricle — the lower chamber of the heart. These can be associated with drops in blood pressure, decreased oxygen supply to the brain, and, eventually, death. Even if not deadly, an abnormal heart rhythm can cause a person to faint, and fainting while in a bathtub is clearly a life-threatening event.
While we may never know what exactly happened in the hotel room that day, Whitney Houston’s autopsy report reads, “Death was due to drowning due to effects of atherosclerotic heart disease and cocaine use. No foul play is suspected. The mode of death is accident.” Simply put, a tragic ending to a complex life.
In the end, we are devoid of celebrity, or wealth, or struggles. We all die alone. And sadly, there is always more to our story.