Expert: Lisa Marie Presley death provides insight into brain and heart functioning

While a detailed account of Lisa Marie Presley’s death has yet to be released, facts have surfaced that add medical context as to how and why she died.

These details provide a pertinent avenue of medical inquiry on the coordinated, life-sustaining functions of the brain and heart.

A matter of timing

Presley, the daughter of Elvis and Priscilla Presley, died on January 12 at age 54. EMS arrived at her Calabasas, CA, home late that morning on a call for an unresponsive woman. Prior to transport, multiple news outlets reported that the EMS crew was able to re-establish a pulse via CPR. Presley died later at a local hospital.

According to Vincent F. Carr, DO, FACC, FACP, CHCQM-PHYADV, a cardiologist and member of the MDLinx medical advisory board, the fact that EMS workers were able to bring back Presley’s pulse at all may be a matter of timing.

While Presley did not have a witnessed cardiac arrest, EMS response time, subsequent CPR, and other life-saving efforts such as defibrillation and/or medications likely contributed to the restoration of her cardiac functioning, Dr. Carr explained.

Second cardiac arrest

The Daily Mail reported that it wasn’t the initial cardiac arrest that led to Presley's death, but rather a second one.^[] Presley was brain-dead upon arrival at the hospital. She was placed in an induced coma and put on life support.

Upon learning she was brain-dead, her family reportedly signed a DNR order. Presley suffered a second cardiac arrest and was allowed to expire sometime later, according to the Daily Mail report.

What caused the initial cardiac arrest remains a mystery, according to a CBS News report.^[] And the Presley family and its fans will have to wait to get clarity, it seems. On January 18, the Los Angeles County Medical Examiner-Coroner's office announced that investigators had yet to pinpoint the cause of the initial cardiac arrest.

Officially, the coroner’s office has deferred the release of a cause of death. CBS News reported that this deferral means that the medical examiner needs more time to investigate with further testing and physician evaluation. There is no timeline for when additional findings will be released.

Meanwhile, the scant details surrounding Presley’s death raise some important medical questions.

Brain and heart function

Dr. Carr explained that heart rhythm is initiated in the heart’s upper chamber, specifically the right atrium. The electrical impulse moves to the atrioventricular node and the bundle branches, which send the impulse to the bottom of the heart at the apex.

“This process is independent of the brain, and the EMS personnel can control and restore the natural rhythm without involving the brain,” Dr. Carr said.

This helps shed some light on the implications of Presley’s second cardiac arrest. The independent relationship of the brain and heart may explain how Presley could have been brain-dead but still had a pulse.

“There are many legal cases [relating to this scenario],” Dr. Carr added. “The Karen Ann Quinlan case is an example of this.”

‘A stormy course’

The fact that it wasn’t an initial cardiac arrest but a secondary one that claimed Presley’s life also raises some questions. Chiefly, how long was Presley in cardiac arrest before her pulse was restored?

Dr. Carr explained that secondary cardiac arrest is not uncommon. The success of stabilization treatment at the hospital often hinges on how long a patient was in cardiac arrest before resuscitation began.

“It is common for patients who have been in cardiac arrest longer than 4 to 5 minutes to have a stormy course,” he said. “The initial defibrillation may have been successful for a short time, yet the patient may return to that abnormal heartbeat repeatedly, particularly in cases of an obstruction to the coronary artery.”

Ultimately, this can be emotionally trying for families as well as HCPs treating the patient. A patient’s death only makes the emotional weight heavier.

 “Caring for the families is another, separate consideration,” Dr. Carr explained. “Families want to talk to the treating physician, and sometimes in the emotion of the situation may not understand the physician’s first concern is the stabilization of the patient, which can take an extended time.”

Important health lessons

While the public may not know precisely what happened to Presley, her tragic death has raised some important points about health, according to Dr. Carr.

First, he said it highlights the importance of advance directives. In the event of cardiac arrest or other tragedies, they take the guesswork and emotional turmoil out of determining what a patient would want if they could speak for themselves.

The second point, according to Dr. Carr, is the importance of family history and lifestyle. In Presley’s case, there have been several instances of cardiac deaths in her family, including her father’s.

“Families with members who have ‘premature’ coronary artery disease, generally considered in parents and siblings before the ages of 45 to 50, must take particular care to avoid smoking, keep their blood pressure under control with medications, keep their cholesterol and blood lipids under control, and keep their body weight under control to help postpone any genetic predisposition to heart disease,” Dr. Carr said.

A highly publicized health incident such as Presley's death could provide a teachable moment in which HCPs can advise patients on the importance of taking such precautions.