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What would happen if a person wasn't able to die of a heart attack since they use a pacemaker or are connected to medical equipment that pumps blood for them?

This can create some sub-questions, if people couldn't die of a heart attack such as:

  • What would happen if the cause of death specified was impossible, so the person had to die of a heart attack?
  • What would happen if no cause of death was specified?
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    They would still die from a heart attack. The pacemaker wouldn't save them for some reason − suddenly break or actually cause the heart attack due to malfunction. At least this is how I imagine it would go, with the powers of death gods involved. – Hakase Oct 19 '14 at 17:42
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Mayo clinic defines heart attack as an obstruction of blood flow to the heart muscle, causing the body's natural blood pump to fail and/or die.

So a pacemaker won't save one from a heart failure once it happens, the device avoids them from happening (the real function is more complex, gugure kokkuri-san!).

Since a heart attack is a failure of the blood pump, it is safe to assume that a DN could make an artificial heart to fail as well.

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    One could comment on how to go cyborg and avoid death by DN, but then we would digress forever on the boundary of what is alive and what is not. So I am really positive that the DEATH GODS in all those centuries perfected the DN to avoid stupid loopholes besides the ones shown onscreen. – Mindwin Dec 3 '14 at 22:49
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How to Use: I

1. The human whose name is written in this note shall die. 


This is the most fundamental rule of the death note. If a person's name is in the death note, this person will die at the specified time or after the standard times. Like Ryuk says: Shinigamis don't normally use the DN in this or that uncommon situation or way. It was Ryuk who wrote the rules (at best copied a manual in the world of Shinigamis) so it is safe to say that the rules don't contain the whole truth.

A Shinigami normally kills human that have several years left - someone who has to use a pacemaker has low chances to live that long - so the Shinigamis just don't know what happens in this case (they are not interested in such things after all) and assume that heart attack is the ultimate fallback but in the end (at least in canon), the DN will never fail.

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