A Heartsick Nation Mourns Newsman's Death

The sudden demise of NBC's popular Tim Russert draws attention to unexpected coronary deaths
June 26, 2008 - Frank Rosci, Jewish Exponent Feature

That unexplained, lethal heart attacks happen often in this country and throughout the world was evidenced again in dramatic fashion recently, when longtime NBC newsman/producer and "Meet the Press" host Tim Russert died of a sudden coronary while at work on June 13.

According to the American Heart Association, there are some 3,000 heart attacks in the United States each day, usually without warning, while coronary heart disease kills nearly 500,000 Americans a year.

Russert seemingly was healthy and had been given a clean bill of health by his doctor after having completed a successful stress test and being within positive ranges in other heart-health indicators -- all shortly before his death at age 58.

So, what happened? What went so terribly wrong? And could it happen to any of us?

"More people die of sudden cardiac arrest every year in the U.S. than from AIDS, lung cancer and breast cancer combined, but it's a myth that the cause is always a heart attack," said Arnold Greenspon, M.D., professor of medicine and director of the electrophysiology lab at Thomas Jefferson University Hospital.

"Less than one-quarter die that way. The real cause is an abnormal heart rhythm that reveals some form of coronary heart disease."

Apparently, he said, Russert was under a doctor's care, but there's no way of knowing for certain what caused his death without autopsy results.

Said Nelson M. Wolf, M.D., professor of medicine and head of the cardiac catheterization lab at Temple University Medical School and Hospital: "Yes, what happened to Russert, a sudden death within one or two hours of a heart attack, can happen to any of us because most sudden deaths are coronary related, and it happens in one of two ways usually.

"The first, that I call sins of the past, isn't a new event but is related to a previous heart attack, characterized by old scarring of the heart and extensive damage to it that leaves the heart muscle very weak.

"So, in this first instance, someone has coronary heart disease in which late arrhythmias can occur that can lead to apparent sudden death. But, if these can be identified in time, a defibrillator can be implanted to help restore normal heart rhythm."

The second kind? "I call [that] evils of the present," and they "can occur when a plaque ruptures, suddenly expands and closes the vessel.

"The person can be shocked, if in a convenient location, during the throes of a heart attack, depending on the size of the attack; but, if not in a convenient location, and the event is severe, the person could die. From what's been described about Russert, this is what seems to have happened to him. This second population is hard to identify and hard to get to."

At the Albert Einstein Healthcare Network, D. Lynn Morris, M.D., chairman of cardiology, talked about primary heart-health steps.

"The first step is that all of us should see our family doctors to have a thorough medical evaluation that would include a good discussion of family history, including a complete cardiac talk, a physical examination and blood work.

"If people are healthy and have no health problems, this kind of general medical work-up should be done yearly for men who are between the ages of 35 and 40, and for women who are 40 to 45, and for older people; and every two years for most younger people with no risk factors and no health problems."

People should also know their risk factors, such as a sedentary lifestyle, smoking, blood sugar and diabetes, high blood pressure, high cholesterol and their family history, said Morris, who acknowledged that based on these facts, doctors can get a pretty good idea of the relative risk of heart disease and heart-related death.

Once the risk has been assessed and appropriate changes are under way, the doctor may order certain tests, including a stress test, which involves walking on a treadmill while having an electrocardiogram; along with a CT scan, a computerized tomography, that can see calcium in the arteries, thus providing some additional information.

"And patients need to be involved in their care by watching for warning symptoms and signs, such as chest discomfort, and by pressing their doctors about what they can do for themselves. Women, especially, should ask their doctors about heart disease since it's never too early to start modifying your lifestyle, taking better care of yourself and working with your doctor," added Morris.

Greenspon said heart health and emergency care should be focused in two areas: public health and public awareness. "People should learn to modify their own risk factors through proper diet and exercise, by reducing their stress levels, and by maintaining a healthy blood pressure, for example.

"Also, people should learn about the warning signs of cardiac arrest, such as chest pressure and pain, as well as learn CPR, and there should be greater public access to [defibrillators ] and learn how to use them, when cardiac arrest occurs. These devices can and do work to shock the heart back to normal function," he explained.

In reality, Wolf said, given the very large number of people living with either diagnosed or undiagnosed heart disease, sudden death happens to only a small percentage of people, but the number is still significant.