I hesitate to devote a post to the recent untimely passing of a lovely young actress who was best known to me from the movies ‘Clueless‘ and ‘Love and Other Disasters‘ because in reading about the unfortunate event in the news, I found the random, almost blase tweets of condolence to be almost distasteful in their casualness. It would seem that the loss of a life (any life) would merit more than 140 characters, and that the actress’ true friends would have more to say than a couple of sentences and I don’t want to be just another one of the masses saying something trite and inane. I suppose for acquaintances and fans, simple RIPs and wishes of comfort and support to her family are more appropriate. And fond memories, so here is one: I screened Clueless with subtitles for the girls in the ESS* when I was teaching at 社高校. It seemed like every 5 minutes I had to qualify with a disclaimer that not all (or really, not many at all) high school experiences were like those depicted in the movie but the girls really liked the characters and the comedy (and really, the plot is not so far removed from some 少女漫画) and I and was struck by how even though the movie was 10 years old and even though I’d seen it a million times, I still loved it as much as I had the first time I saw it. I really enjoyed some of Ms. Murphy’s work and am saddened that she is no longer here to continue it.
The budding clinician in me however, was not so sentimental upon hearing the first scant details about the actress’ death. In fact, the first question that came to mind was ‘what could cause cardiac arrest in a 32 year old apparently healthy woman?’. The initial official reports state that she died from “natural causes”, which makes this case even more puzzling. Usually in young people without congenital heart problems, cardiac arrest is seldom caused by a problem with the heart. In fact, I remember going over a Harvey case with Dr. R (Ross’ resident heart guru) this past semester about cardiac problems in young people (in this case, we were exploring hypertrophic cardiomyopathy vs. aortic stenosis as the underlying pathology) and he mentioned that when you see a case of sudden cardiac death in an apparently healthy young person, you have to put drugs on your list of differentials, as it is the most common acute cause. In addition, given the actress’ history of eating disorders and rumors of recent GI distress, one would also have to consider whether a K+ imbalance caused by vomiting resulted in a fatal arrhythmia… So, cardiac arrest in a 32-year-old female with an unconfirmed prior diagnosis of DM Type II, PMHx of eating disorders, current meds unknown. What would be your list of differential diagnoses? (more…)