This 1999 file photo shows actor James Gandolfini as Tony Soprano. (AP Photo/HBO, Anthony Nesta, file)

You’ve no doubt heard the sad news that Tony Soprano is dead—or rather James Gandolfini, the actor who played him on TV. I was surprised to hear that Gandolfini was only 51. That seems far too young for a heart attack, especially the massive one that purportedly led to his death.

(Officials at the hospital in Rome where Gandolfini was declared dead said the cause of death was likely a heart attack, according to CNN, but that an autopsy will still be performed to determine the exact cause.)

“I don’t know the medical details of his case but the type of heart attacks that cause people to die suddenly involve a totally blocked artery,” said Dr. Robert Yeh, a cardiologist at Massachusetts General Hospital. Over the past decade, incidences of heart attacks this severe—in which a blood clot completely shuts off blood flow to a coronary artery—have declined by 60 percent, according to a study he and his colleagues published in the New England Journal of Medicine.

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“We believe that’s due to a number of things including reduced smoking, better control of blood pressure, and use of statins” to lower high cholesterol levels, Yeh said.

But he also worries that the childhood obesity epidemic will cause these types of heart attacks to rise again once overweight children head into their adult years.

Other cardiologists said Gandolfini’s case isn’t that unusual. “We’ve made huge strides in increasing awarenss and getting people treated as quickly as possible, but there’s still a large number of heart attack patients who don’t get to the hospital quickly enough,” said Reena Pande, a cardiologist at Brigham and Women’s Hospital.

Those experiencing a life-threatening heart attack often have symptoms like chest pain, nausea, heart palpitations, fatigue, or difficulty breathing for hours before they collapse into cardiac arrest. They need to call 911, Yeh emphasized, and get emergency care as soon as possible.

“We’re much better at treating this type of heart attack when patients make it to the hospital quickly than we were 20 years ago,” Yeh said. Typically patients get a catherization procedure to open the artery within 90 minutes after their arrival, and this has proven to be lifesaving.

“Some patients still die,” he added, but often these are the stoic ones that delayed getting to the hospital earlier.

Whether Gandolfini delayed seeking medical care remains unknown, but it’s possible he didn’t have any symptoms before his heart stopped beating.

“Some have cardiac arrest as their first symptom of heart disease,” Pande said. “But this isn’t true for most people.”