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    Why did George Michael’s heart fail?

    28 December 2016

    There is still a huge amount of speculation about the exact reason George Michael died at the early age of 53, and this can only be resolved by a postmortem examination (and even then this is no guarantee of finding a cause). However, I raised an eyebrow when I heard that the current line is that he died from heart failure — a general term and one not often used in middle-aged people.

    As medical terms go, the words ‘heart failure’ aren’t greatly reassuring — it’s as if your doctor were to say you’d better rush home and brush up on your will – and it is a serious medical condition, but ultimately means that the heart of someone suffering from it does not pump blood around their body as well as it should. This in turn means that the blood can’t deliver enough oxygen to the body to allow it to work normally, and that waste products can’t be removed efficiently, causing fluid to build up in the lungs, legs and abdomen.

    Heart failure usually develops as a complication of an underlying heart condition such as narrowing of the arteries, a heart attack, high blood pressure, abnormal heart rhythms or problems with the heart valves. As a result it is also extremely common and becomes more common the older we get — around one per cent of people under 65 years of age have it but this increases to seven per cent in 75-84 year olds, and 15 per cent in people older than 85. It is a little-known fact that heart failure is the most common cause of hospitalisation in patients over 65 years of age, and that a staggering 14 million people in Europe suffer from it — a figure that continues to increase all the time.

    The two main symptoms I tend to see are increasing breathlessness on exertion or exercise, or difficulty in lying flat because of a feeling of shortness of breath. There is also usually swelling of the ankles due to fluid retention, usually worse at the end of the day and better after a night’s sleep. There may also be a general feeling of tiredness or weariness, and some people may develop chest pain or palpitations. Appetite may reduce, and low mood or even depression may occur because of its impact on quality of life.

    Before medication is started there are a number of lifestyle changes that can dramatically improve the situation. Losing weight if you are overweight takes the strain off the heart, as does cutting down on the amount of salt in the diet since salt makes fluid retention worse. It is vital not to smoke because this worsens disease in the heart arteries, and excess amounts of alcohol (occasional drinking at recommended levels is acceptable here) may also further damage heart muscle. A tricky piece of advice is to try not to drink too much fluid — often difficult because heart failure can cause thirstiness — but two litres or less a day should suffice. Protection against flu and pneumococcal chest infections by annual immunisations every year is recommended, as is exercise. The fitter the heart, the better it will pump.

    If medication should be required there are now a number of treatment options available to doctors, and the optimal treatment is usually with several different medications taken each day to produce a combination effect and benefit. These include diuretics (‘water tablets’), drugs known as an ACE inhibitor which have a protective effect on the heart and slow down the progression of heart failure in many people, beta blockers, angiotensin 2 receptor blockers, digitalis, vasodilators and aldosterone receptor antagonists to name but a few. Heart failure caused by abnormal heart rhythms can be treated with devices such as pacemakers and implantable defibrillators, and in extreme cases surgery may be considered, typically in the form of coronary artery bypass grafting, valve surgery or even heart transplantation in a tiny number of cases.

    So why – if it is indeed the case – should Michael die from this condition? One major clue may be his longstanding and self-declared addiction to cannabis, smoking up to 25 joints a day plus ordinary cigarettes on top. Marijuana has been linked to lung infections and in 2011 he was hospitalised in a critical condition with pneumonia from which he made a slow recovery. Tobacco smoke of any kind is a common causeof bronchitis and chronic obstructive pulmonary disease (COPD) and chronic lung disease is a well-known factor in triggering a type of heart failure, with recent studies suggesting that heavy marijuana usage alone may lead to airflow obstruction in the lungs. The sudden death of the singer may indicate that a heart attack linked to heart failure was the ultimate cause and recent photographs showed him looking overweight and tired.

    Whatever the cause of his death, it is another light in the entertainment world that has been snuffed out too soon this year. Let us hope that 2017 is quieter on this front.