What Caused Paul O'Grady's Death?

The cause of TV presenter Paul O'Grady's unfortunate and sudden death has been confirmed as sudden cardiac arrhythmia, his death certificate states. O'Grady openly spoke about his struggles with heart disease having suffered three heart attacks before the age of 65. His husband, Andre Portasio, confirmed that he died “unexpectedly but peacefully”. This is in keeping with a sudden rhythm disturbance.

What is a cardiac arrhythmia?

An arrhythmia is an abnormal heart rhythm. Normally the heart beats regularly and responds to the needs of the body, slowing down at night when asleep, and speeding up when you exercise.

An arrhythmia, by definition, is a heart rate below 60 beats a minute or greater than 100 beats a minute.

However, the more serious ones are atrial fibrillation (as it can lead to stroke), ventricular tachycardia (as it can lead to a collapse), and ventricular fibrillation (which causes a cardiac arrest).


What are the symptoms of arrhythmias?

Too slow a heart beat can cause a collapse, and a pacemaker is sometimes needed. It can also lead to breathlessness and fatigue.

Too fast a heart beat can also lead to collapse, and sudden death. It can also cause breathlessness and chest pain. You might actually feel the heart beat going fast, but sometimes it is not obvious to you.

It is likely that Mr O’Grady suffered ventricular fibrillation (VF), which, unless treated immediately, is fatal. This causes a cardiac arrest.


What can cause cardiac arrhythmia?

Given that Mr O’Grady had had several heart attacks in the past (in 2002, 2006 and 2014) his heart would have had scar tissue on it. This makes it prone to arrhythmia, including VF. Thus a structurally abnormal heart is the commonest cause. However, abnormal blood salts can also upset the heart, and so cardiologists always check your blood tests to pick up any correctable abnormalities.

In addition, some medications, for example, psychiatric drugs, anti-histamines, and many common drugs used to help the heart, can also cause an arrhythmia in some people.


When should I be worried about an irregular heartbeat?

If your pulse is irregular, it should be investigated to find out why.

With the use of electronic devices such as smart watches and Fitbits, you often get an alert that the pulse is irregular. Don’t worry- it is probably nothing. But it should be checked out.

If you can actually FEEL that you have an irregular pulse, and it is troubling you, then you should be assessed. It may just be an occasional extra heart beat (an ectopic beat), but it is important to exclude a more serious condition such as Atrial Fibrillation (AF).

If you have chest pain or breathlessness at rest, you should seek emergency help with this.


What tests might help work out what it is?

The key test is to catch the arrhythmia on an ECG (electrocardiogram).

Of course a detailed history and examination will be needed, and blood tests. In addition, the echocardiogram will help work out if the heart is structurally OK.

We often need to go for longer term investigations with a ECG monitor for 24 hours, up to 1 month on occasion, to see what is going on. We can also implant an “chip” in you which monitors the heart continuously.


What can be done if there is a high risk of cardiac arrest?

If we assess that you are at high risk of cardiac arrest (this is different from a heart attack, when a blood vessel in the heart blocks), then there are several things to do.

  1. Treat the underlying cause- to reduce the risk. For example:
    1. Replumb the heart if the blood vessels are narrowed
    2. Correct any blood salt abnormalities
    3. Use the correct medication to strengthen the heart and help it recover
  2. Use specific medication to try to lower the cardiac arrest risk
    1. Beta-blockers and amiodarone are two examples of specific anti-arrhythmia drugs
  3. Use an Implantable cardiac Defibrillator (ICD) to reset the heart back to normal in the event of a cardiac arrest.

Summary

It is likely that Paul O’Grady either:

  • Had cardiac arrest due to a sudden arrhythmia such as VF because of scarring on his heart,
  • OR this arrhythmia was set off by a blood vessel suddenly blocking (a heart attack), with the 1st symptom being VF, leading to sudden death.

If you have any concerns about your heart please get in touch with my team at OneWelbeck. We would be happy to help.


Written by Dr Iqbal Malik

Dr Iqbal Malik is a consultant cardiologist and Medical Director of OneWelbeck Heart Health, specialising in coronary artery disease and structural heart disease including PFO, ASD and the TAVI procedure.