The sudden death of 32-year-old actress Brittany Murphy from a reported cardiac arrest on Sunday morning has left her friends and loved ones scrambling for answers, and the public wondering what could have ended the former Clueless star’s life so abruptly. Initial reports suggests that Murphy died of natural causes, and an autopsy, which will include tests for drugs and alcohol, is currently being conducted. To learn more about what could possibly have caused sudden cardiac arrest in the young actress, TIME spoke with Dr. Douglas Zipes, former president of the American College of Cardiology.
“There are a number of inherited abnormalities that can predispose someone to abnormal heart rhythm problems,” which can cause sudden death, Zipes says. The most dangerous kind of abnormal heart rhythm, often referred to simply as “massive heart attack,” is ventricular fibrillation—”or a rapid heart beat coming from the bottom chamber of the heart, when the heart beats 400 to 600 times per minute and is totally ineffective at pumping blood,” Zipes explains. (For normal adults, a healthy resting heart rate is between 60 to 100 beats per minute.) “Basically the heart looks like a bag of squiggly worms with no squeeze to make the blood go to the brain,” Zipes says. Ventricular fibrillation can be caused by a range of factors, from a genetic heart defect to coronary heart disease or even infections of the heart, and once the heart has gone into ventricular fibrillation, there is very little time to react. “You have eight to 12 seconds before you black out,” Zipes says, and the only effective way to resuscitate you is with the shock of a defribillator.
In men over age 35, most frequently the underlying cause of an abnormal heart rhythm resulting in death is coronary disease, and too often people don’t realize they have the disease until it’s too late. In coronary disease, “half of the sudden deaths are the first manifestation of underlying heart disease,” Zipes says. “That’s a terribly sobering fact. The first time you knew you had heart disease was when you dropped dead.”
In people under age 35, and particularly women under age 35, coronary disease is less likely to be the cause of a sudden cardiac arrest. Cardiomyopathy, a condition characterized by abnormalities in the heart muscle, can predispose people to heart attack, and while it can still sneak up on individuals, there are generally more warning signs such as “heart palpitations or the feeling that your heart is racing, or a non-lasting episode of ventricular tachycardia,” Zipes says. Ventricular tachycardia is “a slower form of a rapid heart beat that can be anywhere from 150-300 times per minute, and if it’s in the lower range, you may have a lightheaded spell or a transient black out spell.”
Another possible heart condition that could lead to ventricular fibrillation is known as Long QT Syndrome, which basically means that the heart takes an abnormally long time to recover after each beat, Zipes says.
Reports that Murphy was suffering from flu-like symptoms before her death could also suggest the possibility of myocarditis, or swelling of the heart muscle caused by viral infection. As Zipes explains, “a virus can infect the heart muscle itself, cause inflammation and result in cardiomyopathy or abnormal heart rhythm and sudden death.”
Of course, Zipes says that medication can lead to abnormal heart rhythms as well, especially in individuals with underlying but undetected heart conditions, and it isn’t just hard drugs that can cause these problems. “It doesn’t have to be cocaine or amphetamine, but it can be a constellation of very simple drugs,” he says. He cites examples of people who have Long QT Syndrome but are totally asymptomatic until they take certain combinations of over-the-counter drugs or an antibiotic like Azithromycin. Murphy was reportedly taking several prescription medications in the days before she died.
Until the coroner’s report is complete, a process that can take up to eight weeks, it will be unclear what caused Murphy’s death at such a young age, but if there is anything to be gained from her tragically young demise, it may be a raised awareness of the dangers of sudden death, Zipes says. “There are approximately 1,000 sudden deaths a day in the United States,” he says, roughly the equivalent of “three 747s crashing every day with no survivors. This is a very real problem in the U.S.” For individuals, he emphasizes the importance of seeking medical attention if you experience “any kind of symptoms that may be due to your heart: chest pain, shortness of breath, dizzy spells, palpitations, the feeling of your heart racing or beating irregularly.” From a broader, public health standpoint, Zipes applauds efforts to outfit public spaces such as airports with defibrillators, but emphasizes the alarming statistic that “80% of the sudden deaths occur in the home.” Murphy was in her Los Angeles home when fire fighters got an emergency medical call on Sunday morning, and was pronounced dead about two hours later at nearby Cedars-Sinai Medical Center. “This is an area that really needs far more research,” Zipes says. “There needs to be some approach to identifying and then being able to treat sudden death in the home.”