Whitney Houston's Death: What Is Atherosclerosis?

Medical Author: Benjamin Wedro, MD, FACEP, FAAEM
Medical Editor: Charles Patrick Davis, MD, PhD

It should come as no surprise that Whitney Houston's autopsy showed that she had died because of atherosclerotic heart disease. After all, heart attack is the most common cause of death in the United States. It's the words that get in the way of understanding what happened to Ms. Houston and almost 600,000 victims of heart disease every year. Atherosclerosis describes narrowing and “hardening” of the arteries and when the arteries in the heart get too narrow, disaster happens.

The heart is a muscle and like any other muscle in the body. It needs enough blood supply to provide oxygen to every one of its cells. The coronary arteries supply heart muscle cells with blood, but that blood supply can be decreased if plaque, a buildup of cholesterol and calcium, starts to narrow the artery. If the artery narrows enough, when the heart works harder during exercise or activity, there may not be enough blood flow and oxygen delivery causing the heart muscle to ache. Welcome to angina. Now, if you run too hard and your legs ache you can stop. If you lift too much and yours arms get sore, you can stop. Your heart can't stop beating and classically, the pain of angina makes the patient stop their activity or slow down to give the heart a chance to catch up. If the plaque in a coronary artery ruptures, it can cause a blood clot to form that prevents any blood flow and the heart muscle downstream loses all its oxygen and dies. This is a heart attack or myocardial infarction.

Heart muscle that lacks oxygen becomes very irritable and can cause short circuits in the heart's electrical system. Cardiac arrest or sudden death occurs in a heart attack when ventricular fibrillation, a chaotic electrical rhythm does not allow the heart to beat in an organized way and pump blood to the body.

There are many risk factors that can cause atherosclerosis including high blood pressure, high cholesterol, diabetes, and smoking. By themselves or together, they cause the scarring and inflammation on the inner wall of the artery that can cause the initial small plaque to form. That plaque grows over time until it becomes symptomatic. Lifelong body maintenance helps decrease the risk of atherosclerosis and heart attack.

There are other risk factors but they don't get much press outside of medical circles. However, cocaine gets to share the spotlight as a cause of Ms. Houston's death. Cocaine use increases blood pressure, heart rate, and the heart's requirement for oxygen. But cocaine also causes the coronary arteries to spasm and prevents much needed blood flow to the heart muscle. This can cause a heart attack with chest pain, shortness of breath, sweating, nausea, and an abnormal EKG. If a heart catheterization is done and there is no clot, there is nothing to fix...until the patient gets a little older. If there is underlying atherosclerosis or narrowing, cocaine use dramatically increases the risk of heart attack and the risk of death.

Ms. Houston was found submerged in the bathtub of her hotel room and drowning was listed as one of the causes of death. There are many potential reasons that she may have drowned. The first might be the heart attack/ventricular fibrillation scenario where sudden death causes her to slide underwater. A second could be that the sedatives that were also found in her toxicology tests may have made her fall unconscious and submerge her head underwater. Since she was alone at the time, the true reason will likely never be known.

The invincibility of youth provides a false sense of security when experimenting with all types of behavior. The problem arises when the invincibility of youth is carried into adulthood and experience does not temper behavior and common sense fails. The sadness for Ms. Houston was that she might have been able to survive atherosclerosis by itself or cocaine use alone, but she could not survive the combination of the two.

REFERENCE:

Kochanek, Kenneth D., et al. "Deaths: Preliminary Data for 2009." National Vital Statistics Reports 59.4 (2011). <http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf>.


Last Editorial Review: 3/28/2012 5:29:32 PM



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