Dr. Kohli On Lisa Marie Presley's Fatal Cardiac Arrest

On January 12, singer and songwriter Lisa Marie Presley, daughter of the legendary Elvis Presley, suffered cardiac arrest at her Calabasas, California home. Despite all efforts to save her, including CPR being administered en route to the hospital, she died later that day. She was only 54 years old.

DocWire News Medical Lead Payal Kohli, MD, FACC, spoke about the known details of Lisa Marie’s death, whether her past history of illicit drug use may have played a factor, and about the possibility of cardiac arrest running in her famous family.

DocWire News: What details do we know about the death of Lisa Marie Presley?

Dr. Payal Kohli: Very unfortunate to lose her at such a young age. And what we have heard from news reports is that, obviously, she got CPR and also that epinephrine was used in an attempt to try to resuscitate her. And she actually passed away later at the hospital. And we don’t at this point know exactly what caused her cardiac arrest, and we don’t know whether it was a primary metabolic issue, like something to do with her electrolytes or her oxygen levels or the acid-based balance of her blood, or whether it was an arrhythmia that caused her cardiac arrest. In other words, was it a electrical problem with the heart or something structural with the heart that caused it to stop beating?

Lisa Marie Presley had a well-known addiction to pain killers and opioids. Could that addiction have contributed to her untimely death?

It’s hard to speculate exactly what happened, but certainly, in patients who have used illicit drugs, there are many different mechanisms by which they can lead to cardiac death. So the first is, obviously, an immediate mechanism. So if you use a stimulant drug, like cocaine or methamphetamine, that can cause vasospasm of the coronary arteries. That can cause cardiac arrhythmias. That can cause aortic dissections. That can cause myocardial ischemia. That can have a number of different mechanisms by which it can cause the heart to stop or misbehave. If you use more depressant drugs acutely, like opiates or heroin or other such drugs, that can actually suppress your respirations, your breathing, which can make your oxygen levels go down. And then the heart reacts to that low oxygen or the hypoxemia, and that can cause a problem with the oxygen levels and the heart stopping because of that. That’s in the acute setting.

Now, more chronically, whether it’s meth, cocaine or other illicit drugs, they can actually cause cardiomyopathies, or weakening of the heart muscle. Once the heart muscle starts weakening, starts getting stretched out, you can start to have higher risk for arrhythmias and develop electrical abnormalities as well. So very hard to know in her specific case whether the drug use was linked or not, but patients with illicit drug use are at higher risk for having cardiac arrest.

Her father, Elvis Presley, famously died from cardiac arrest as well. Is there a possibility that Lisa Marie had a hereditary heart condition?

Again, in this particular case, really hard to know what led to Elvis’ cardiac arrest, if it was related to primary arrhythmia or something else. But in general, cardiac arrest can certainly run in families. In fact, that is a condition, long QT, short QT, that can be genetically acquired. So when you’re talking to someone, it’s really important to ask them if they have a family history of losing a family member suddenly for no good reason. Thankfully, in 2023, there are a number of different ways, including genetic testing and others, in which we can actually risk stratify individuals who are at higher risk for cardiac arrest based on their family histories. But yeah, certainly cardiomyopathies run in families. Channelopathies that can cause the electricity to misbehave run in families. So there is very much a familial component to cardiac arrest in certain individuals.

What are the takeaways from her death?

Her unfortunate death tells us something, which is that heart disease is still the number one killer of women, and she certainly was a young woman. If you actually look at the statistics in terms of sudden cardiac death in women, there’s some differences. So women who have sudden cardiac death are less likely to have preexisting heart disease, whether on EKG or whether structurally. We also have seen some data come out that tells us that women are more likely to have cardiac arrest at night as opposed to men. So some interesting differences that we’re still kind of parsing out exactly what we understand. Unfortunately, the sudden cardiac death mortality in women has remained high, whereas we’ve made some progress in men. So it’s really important for us to remember to give our women bystander CPR as well and make sure we try to really bridge some of that gender gap.