We still don’t know what killed Anna Nicole Smith

Broward County Medical Examiner Joshua Perper said Smith died of “combined drug intoxication” with the sleeping medication chloral hydrate as the major factor.
But as Mickey from SimulConsult told me last month (When sudden death runs in the family)
Two odd deaths in a family [Smith’s son’s death at age 20 was blamed on a combination of methadone and antidepressants, which caused cardiac dysrhythmia] raise the possibility of inherited diseases such as the Cardiac Long QT syndrome or a hereditary cardiac malformation.
Mickey is unpersuaded by today’s announcement:
Chloral hydrate is seldom associated with death, at least as the only medication. When a woman and her son both die suddenly, one has to consider heritable causes as well as bad luck or multiple medications. Chloral hydrate is on the list of drugs associated with the Long QT syndrome and we are told that she was taking other medications as well. The syndrome is a channelopathy that can be tested for using DNA.
March 26, 2007

3 thoughts on “We still don’t know what killed Anna Nicole Smith”

  1. OK, someone besides me is thinking. The DNA may or may not tell them anything that is helpful because not every genetic deformity for LQTS is known. But it is a real reason to have Dannielynn seen by a pediatric cardiac electrophysiologist and maybe have her monitored with ekg testing as she grows up.

  2. Um, I remember vaguely from my internal medicine rotation was that when you hear hoofbeats, think horses, not zebras. Or, more succintly, common things happen commonly.

    The woman had in her system no fewer than six or seven drugs which are known to cause respiratory depression. Is there any reason to think that anything OTHER than that caused her death?

  3. If this were an isolated incident it would be easy to dismiss it as a drug interaction. Indeed, that is the most likely answer. However, because her son died under similar circumstances, with far less in the way of drugs onboard, one needs to consider a genetic cause as well.

    Over 40,000 people in the US have this genetic defect, and over 10% of them will die from it, often as young adults. With a strong genetic history it is worth checking for the possibility that the cause of death was drugs acting on a genetic susceptibility.

    After Ms. Smith’s son died suddenly last year it would have been prudent to get an EKG on her to see whether she was at risk. Now that two of them have died it is worth checking other first degree relatives. Even if the chance of long QT syndrome is only 1% it is worth checking because the test on a living person is inexpensive and death from the long QT syndrome is very preventable.

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