By DENISE GRADY
Given the great strides that have been made in preventing and treating heart disease, what explains Tim Russert’s sudden death last week at 58 from a heart attack?
The answer, at least in part, is that doctors knew that Russert, the longtime moderator of “Meet the Press” on NBC, had coronary artery disease and were treating him for it. But the severity was not apparent because he had no chest pain or other telltale symptoms that would have justified the kind of invasive tests needed to make a definitive diagnosis.
Russert was doing nearly all he could to lower his risk. He took blood pressure pills and a statin drug to control his cholesterol, he worked out every day on an exercise bike, and he was trying to lose weight, his doctors said Monday.
Still, it was not enough.
If there is any lesson in his death, his doctors said, it is a reminder that heart disease can be silent, and that people, especially those with known risk factors, should pay attention to diet, blood pressure, weight and exercise – even if they are feeling fine.
“If there’s one number that’s a predictor of mortality, it’s waist circumference,” said Dr. Michael Newman, Russert’s internist.
Newman added that most people would rather focus on their low- density lipoprotein, or “bad,” cholesterol instead of taking measures to reduce their waist size. Studies have found that a waist size of over 40 inches in men and 35 inches in women is a risk factor for heart disease.
Russert’s cholesterol was not high, and medicine controlled his high blood pressure pretty well, Newman said. But, he added, Russert was “significantly overweight.” He also had a dangerous combination of other risk factors: high triglycerides, a type of fat in the blood, and a low level of high-density lipoprotein, or “good,” cholesterol that can help the body get rid of the bad cholesterol that can damage arteries.
Russert’s cardiologist, Dr. George Bren, said the autopsy found significant blockages in several coronary arteries, which feed blood to the heart muscle.
Blockages start out as cholesterol deposits in the artery walls that turn into lesions or plaques, narrowing the vessels. Heart attacks occur when a plaque ruptures, causing a blood clot that quickly closes the artery and pinches off the blood supply to part of the heart.
In Russert’s case, the heart attack was caused by a plaque rupture in a branch of the left anterior descending coronary artery. The heart attack led to an abnormal heart rhythm that stopped his heart from pumping blood effectively and caused his death.
“What is surprising,” Newman said, “is that the severity of the anatomical findings would not be predicted from his clinical situation, the absence of symptoms and his performing at a very high level of exercise.”
Newman and Bren said that in the past year, Russert’s blood pressure had risen a bit and that they had changed his drug regimen to lower it. His heart muscle had thickened. Some cardiologists say a thickened or enlarged heart can indicate severe heart disease and should prompt more tests, such as an angiogram, to look for artery blockages. But those tests are invasive, and Russert’s doctors did not think he needed them.
silent killer
More than 50 percent of all men who die of coronary heart disease have no previous symptoms, the American Heart Association says.
what is too big?
Studies have found that a waist measuring over 40 inches in men and 35 inches in women is a risk factor for heart disease.
What is a heart attack?
When low blood flow starves the heart of oxygen, heart muscle dies or becomes damaged. That’s a heart attack. Doctors call it a myocardial infarction.
What causes it?
Most heart attacks are caused by a blood clot that blocks one of the arteries that bring oxygen to the heart. A clot most often forms in a coronary artery that has narrowed because of the build-up of plaque. Occasionally, sudden overwhelming stress can trigger a heart attack.
How common is a heart attack?
About 1 million patients visit the hospital each year with a heart attack. About 1 out of every 5 deaths is attributed to a heart attack. It is hard to estimate exactly how common heart attacks are because many people die before medical help is sought.
Am I at risk?
Common risk factors for heart attack and coronary artery disease include genetics; being male; diabetes; age; high blood pressure; smoking; a fatty diet; unhealthy cholesterol levels; and high levels of homocysteine, C-reactive protein and fibrinogen.
How do I know if I am having one?
Chest pain is a major symptom of heart attack. But some people may have little or no chest pain, especially the elderly and those with diabetes. The pain may be felt in only one part of the body or move from your chest to your arms, shoulder, neck, teeth, jaw, belly or back. The pain can be severe or mild. It can feel like squeezing or heavy pressure and usually lasts more than 20 minutes.
Other symptoms of a heart attack include:
Shortness of breath; nausea or vomiting; anxiety; coughing; lightheadedness or dizziness; and palpitations.
What should I do?
A heart attack is a medical emergency. If you have symptoms, seek immediate medical help.
What happens at the hospital?
If you had a heart attack, you will need to stay in the hospital, possibly in the intensive care unit. You will be hooked up to a monitor so health care specialists can look at how your heart is beating. Life-threatening arrhythmias, or irregular heartbeats, are the leading cause of death in the first few hours of a heart attack.
The health care team will give you oxygen, even if your blood oxygen levels are normal. This is done so your body tissues have easy access to oxygen, so your heart doesn’t have to work as hard.
What treatments are available?
Certain patients may be given blood thinners. This is called thrombolytic therapy. Blood thinners taken by mouth may be prescribed later to prevent clots from forming. The therapy is not appropriate for all patients.
Many different medicines are used to treat and prevent heart attacks.
Nitroglycerin helps reduce chest pain.
Anti-platelet medicines help prevent clot formation. Aspirin is an anti-platelet drug. Another one is clopidogrel (Plavix).
Beta-blockers help reduce the strain on the heart and lower blood pressure.
ACE inhibitors are used to prevent heart failure and lower blood pressure.
SURGERY AND OTHER PROCEDURES
A procedure called angioplasty may be needed to open blocked coronary arteries. Angioplasty with stenting can be a life-saving procedure if you are having a heart attack. However, for people with coronary heart disease, recent studies show that medicine and angioplasty with stenting have equal benefits. – The New York Times
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