Sridevi passes away: What factors contributed to her tragic death?

 Dr KK Aggarwal

Recipient of Padma Shri

Actress Sridevi passed away at the age of 54 years due to sudden cardiac arrest on Saturday. While her family (actor Sanjay Kapoor) has said that she had no history of heart disease, a Facebook post and Whatspp message is being circulated that blames her untimely death on plastic surgeries and other cosmetic procedures she may have undergone in an effort to ward off signs of aging and look young.

The post, whose authenticity cannot be verified says “Society demanded that she stay slimmer/look younger than a40-year-old and hence, the continuous surgeries. When I met her about 5 years ago, she was beautiful but a sad version of that self that we loved so much in a movie like Chandni. What a lot of pressure to keep her weight down, to make sure that her face had no wrinkle lines....continuous clinic visits in Southern California” (Read more at: https://www.oneindia.com/india/plastic-surgeries-desire-look-young-could-have-led-sridevi-s-death-claims-viral-post/articlecontent-pf31730-2648473.html)

Repeated plastic surgeries per se cannot cause sudden cardiac arrest, however, the associated stress can lead to such an adverse event. The stress of surgery and the recuperation process may result in some degree of depression. A person who is already insecure about their appearance may become severely depressed if the result of the surgery is not what he/she expected to be.

Job dissatisfaction and relational disharmony can be factors in a sudden adverse cardiac event. She ruled the Hindi film industry as the no. one female star in the 80s. She was also an acclaimed actress in the South film industry. Her elder daughter was to make her debut in Hindi films. So, she had something to look forward to.

It is being said that she was on a weight loss diet. A ketogenic diet is a diet which has low carbs, high fats and adequate proteins (1 gm/kg body weight). It is a type of starvation diet (starvation of carbohydrates), which puts the body into a metabolic state called ketosis, wherein the body derives energy from ketone bodies unlike a normal, higher carbohydrate diet, where glucose is the source of energy. And, the extra glucose is converted into fat, which is then stored. A ketogenic diet therefore burns fat rather than carbohydrates, resulting in weight loss.

Cardiac arrest in the setting of diet pill consumption has been reported. The American Journal of Emergency Medicine has published a case describing ventricular tachycardia/fibrillation arrest in an otherwise healthy 48-year-old woman who was taking no medications other than phentermine, a common appetite suppressant. It has been suggested that phentermine, which is a chemical analog of the potent amphetamine class of noradrenergic stimulants, may promote potentially fatal cardiac outcomes (Am J Emerg Med. 2008 Jul;26(6):732.e1-3). Vigorous physical activity also may be a potential trigger of sudden cardiac arrest in some patients (Int J Cardiol. 2009 Jan 24;131(3):345-9).

These factors may not have contributed to her death, as was being circulated on social media earlier.

However, yesterday, quoting the Dubai government's media office feed on Twitter, the PTI reported that “Following the completion of post mortem analysis, Dubai police headquarters stated that the death occurred due to drowning in her hotel apartment's bath tub following loss of consciousness.” The Dubai-based Gulf News said in a report that the actor was under the influence of alcohol. She fell into the bathtub and drowned. It also attached a copy of the UAE government's forensic report on its Twitter handle. The report, citing accidental drowning as the cause of death, has a stamp of the "Ministry of Health UAE" and the director of preventive medicine, Dubai, Dr Sami Wadie.

A normal person would not drown in a bath tub unless he/she is unconscious or is under the influence of alcohol, which was found only in traces.

Perhaps she had a cardiac arrest and she fell down in the bath tub or she became unconscious and fell down in the bath tub, leading to her accidental drowning.

The delay in handing over of the body and the forensic report is not because any foul play is suspected. The normal procedure in UAE takes about 4-5 days. This is usual.