How Did Elvis Presley Die?

On August 16, 1977, Elvis Presley was found unresponsive on the bathroom floor of his Graceland home at age 42, tragically cutting short the life of one of the world’s most celebrated performers. Officially attributed to cardiac arrhythmia, his death has long sparked questions. In the decades since, it has been linked to long-term prescription drug use and a range of serious health problems—including severe constipation and heart, lung and liver disease, some of which may have had a genetic component.

In the final weeks before Elvis Presley died, the iconic singer stayed at his Memphis home Graceland for longer than he had in years. Previously, he’d split his time between there, Los Angeles, Palm Springs and Las Vegas. But after his last concert at the Market Square Arena in Indianapolis, Indiana, on June 26, 1977, Presley convalesced at the 13.8-acre Tennessee estate he purchased 20 years earlier.

“He wasn’t feeling good,” says Sally Hoedel, a journalist and author who has written extensively about Presley’s death, including the book Elvis: Destined to Die Young. In addition to spending time with his 9-year-old daughter Lisa Marie and his fiancée Ginger Alden, Hoedel says, he also stayed in his room a lot as he prepared for his upcoming tour, scheduled to start August 17, 1977.

“People told Elvis to cancel the tour,” says Hoedel. “But he’d say, ‘I can’t.’ People were relying on him.” On his last day alive, Presley played a short game of racquetball with his cousin Billy Smith, sang at the piano and, according to Smith, declared: “This is gonna be the best tour yet.”

On August 16, 1977, around 2:30 p.m., Alden found Presley unresponsive on his bathroom floor at Graceland. He likely had been dead for several hours as rigor mortis had already set in, says Hoedel. He was rushed to Memphis’ Baptist Memorial Hospital, where doctors officially pronounced him dead an hour later. 

The Shelby County coroner declared the official cause of Presley’s death to be cardiac arrhythmia, or an irregular heartbeat. But there were numerous underlying factors, asserts Hoedel, who says Presley had “heart, liver and lung disease that were genetic in nature. We see it in his family tree… One doctor I talked to said he was like a ticking time bomb. He really was a very ill man.” 

The question has lingered for decades. Historians and physicians believe Presley died at some point between 4 a.m. and 9 a.m. after trying to have a bowel movement in the middle of the night. 

According to Hoedel, Presley's personal physician Dr. George C. Nichopoulos said Presley would strain to have bowel movements because he didn’t want to appear bloated on stage. According to Nichopoulos, he suffered from a severe form of megacolon, which meant his colon was twice its normal diameter and, at the time of his death, dangerously impacted with stool—likely for months.  

Those digestive and constipation challenges may have contributed directly to his death. According to one prevailing theory, Hoedel says, “he would have been straining in the bathroom using the Valsalva maneuver,” which compressed his abdominal aorta and shut down his heart. “It created cardiac arrhythmia, because he already had the heart and liver issue, so blood was not returning to his heart as fast as it should.”

Years of consuming sedatives, amphetamines and narcotics may have actually worsened his underlying health conditions—including his severe constipation. According to The New York Times, prosecutors in a 1981 criminal case against Dr. Nichopoulos established that he “prescribed more than 19,000 doses of narcotics, sedatives and stimulants to Mr. Presley in the 31-plus months before the entertainer died Aug. 16, 1977.” The singer’s post-mortem toxicology report listed more than a dozen different drugs in his system, including morphine, codeine, Quaaludes, Demerol, Valium and more. (Nichopoulos was ultimately acquitted of criminal wrongdoing, but lost his medical license years later.)

In the first half of 1977, Presley performed in 60 concerts. After taking amphetamines to help him be more active while on stage, the singer would then consume sedatives to try to treat his insomnia, a debilitating cycle that wreaked havoc on his body. 

“You see him struggling on stage,” says Hoedel. “His stomach, hands and legs are bloated. Those are signs of congestive heart failure because his heart is not pumping as it should. He repeatedly tells people his body hurts everywhere.” For his part, Dr. Nichopoulos attributed the bloat to the singer’s acute constipation.

In the years prior to his death, Presley was hospitalized numerous times. Ailments included hypertension, muscle pain, arthritis, glaucoma, and colon, liver and lung issues. Through it all, Presley kept performing to help maintain his costly lifestyle and provide for the friends and family who had become financially dependent on him.

“He has this incredible generosity,” says Hoedel. “It’s a blessing and a curse: It’s lovely he helps so many people. It hurts him because, in the end, he can’t stop touring, and he keeps turning to the medication over and over so he can keep being Elvis Presley.”