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Deadly heart attacks often come without warning

Posted by Elizabeth Cooney June 13, 2008 07:24 PM

Dr. Randall Zusman, director of the section for hypertension in the cardiac division of Massachusetts General Hospital Heart Center, answered questions about sudden, fatal heart attacks after the death earlier today of NBC newsman Tim Russert. Zusman spoke in general terms about heart disease, the number one killer of Americans.


How common is such a quick and deadly attack?

It's not uncommon by any means and often occurs in previously asymptomatic patients. Over a million people in this country have a heart attack each year and unfortunately about a third of these are fatal. Often it's the patient's first symptom or first sign of heart disease.

In many of these circumstances patients either fail to report or ignore prior symptoms. And that is bewildering when someone has a sudden and immediately fatal event. Did they have atypical symptoms instead of tradition chest pains? They may have had arm, shoulder, or jaw pain. Some people have abdominal pain that is indicative of heart disease.

What happens in a sudden heart attack?

The formation of a blood clot within the blood vessel leading to the heart prevents blood flow to whatever region of the heart supplied by that artery. That part of the heart muscle dies and the pumping function of that muscle is lost. That results in heart failure or shortness of breath. It sometimes results in an electric instability of the heart so that extra heartbeats are generated and often disintegrate into a disordered electrical rhythm that is ineffective. That results in a drop in blood pressure and further inadequate blood supply to the heart.

What can anyone do then?

The only opportunity is when you can immediately be resuscitated, both chest compressions and respiratory support, and immediately defibrillated (to restore the proper heart rhythm).

Could a portable AED help in a situation like this?

That's what they are designed to do, but sometimes the amount of (heart) muscle loss may be too great.

What can be done to lower the risk of heart attack?

The risk factors are elevated cholesterol and blood pressure, diabetes, tobacco abuse, a sedentary lifestyle, a family history of heart disease, being male, progressive age, being overweight.

You can't stop the aging process or change your family history but we do have effective therapies to control cholesterol and blood pressure and treat diabetes. People can stay physically active, lose weight, stop smoking.

The incidence of heart disease is falling, but we still haven't successfully eliminated it as a major cause of death in Americans.

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32 comments so far...
  1. i am not trying at all to be a smart ass here...but could it be possible that Tim Russerts long plane ride back from Italy could have resulted or contributed to his demise? For some reason I seem to recall that it is simply not good at all to sit in a plane for hours....that blood can pool in the legs...and that same pooling can cause clots to form....I know it might never be said publicly...as it would cause too much bad press for an already suffering industry...the airline industry..... I just have this totally non-qualified opinion...as i am surely not a doctor.....but i can't help but think about this idea.....and it makes me even sadder. Did he collapse in the studio...shortly after landing from his long flight from Italy?

    Posted by jwood June 13, 08 09:37 PM
  1. what a wonderful man tim russert was.........and why on earth isn't this being framed as it should be, a MEN'S HEALT crisis. imagin if woman after woman died suddenly and young....we'd never hear the end of it.

    Posted by fc June 13, 08 10:07 PM
  1. This guy was a freakin legend.

    Posted by Jimmy Carter June 13, 08 10:15 PM
  1. jwood,

    What you are describing is a pulmonary embolism. It is very different than a heart attack, but not knowing all that happened with Tim Russert I don't have an opinion on what happened to him.

    Posted by mgc June 13, 08 10:23 PM
  1. Typically the blood clotting that's associated with long airplane flights occurs in the lungs and is referred to as a pulmonary embolism (PE). The clotting starts in the legs resulting in Deep Vein Thrombosis (DVT); a clot dislodges and makes its way to the lungs. Tim clot was located in the heart system. But to your central question, could the long flight contributed? A question better answered by the experts.

    Posted by David June 13, 08 10:37 PM
  1. Or perhaps he, in fact, did have symptoms or contributing factors, that no one is aware of....I too have heard of the "blood clot" after long plane rides- but, wasn't there also a journalist in Afghanistan, shortly after we started the war, that died after hours and hours of riding in a vehicle and not getting out and moving about? I forget his name, but I remember the circumstances. He was also very young. In any event, regardless, it's truly sad. My condolences to his family.

    Posted by HD June 13, 08 10:38 PM
  1. I understand from watching Keith Olberman that Tim R. was under the stress of having to place his beloved father into assisted living in Buffalo while having to consider his son's graduation and his Italian journey. My arrhythmia got much worse last year, when my mother survived an emergency surgery and also had to go into an assisted living place, after long rehab. I too was wondering about that long plane ride, but I imagine that Tim traveled by first class, which does make a difference. And yes, the news did say that he did collapse in the studio, leaving us all in shock and deep morning for this much loved man.

    Posted by Eva S. June 13, 08 10:44 PM
  1. There is nothing smart-ass about your observation. Several of us opined about the same exact thing tonight. It certainly wouldn't be the airline's fault. They are very clear in their literature how people have to get up during a flight and Tim would be the type of guy that would be cognizant of this and get up periodically with that thought in mind. Tim's untimely and very sad death is more likely bad luck. What an awful loss for his family and friends and all of his many fans. I am very sad and my heart goes out to his wife, son, and dad.

    Posted by Marge June 13, 08 10:57 PM
  1. I thought the exact same thing after I read another article which stated that they found "fresh clots" in his coronary artery... It also said that one of the risks for a coronary embolism is sitting in a hospital bed or on an airplane for a long period. How hideous is that?

    Posted by gloria badal June 13, 08 11:24 PM
  1. We have lost a Great American. He was someone for all to look up to. Please pray for his family. Thank you Mr. Russert you will be missed.

    Posted by Phil Hamilton June 13, 08 11:25 PM
  1. Why in the world do you offer such unsubstantiated rhetoric at a time like this wood? There are many, many factors that may have contributed. My God! Perhaps Mr. Russert's family would rather ponder the times they spent together on that trip rather than the trash you would want them to ponder. You are right on one count........you are TOTALLY unqualified and opinions from people like you are best kept to oneself. Get some sleep.

    Posted by pata June 13, 08 11:50 PM
  1. no.. what you're referring to is a pulmonary embolus. Remember basic anatomy.. a blod clot that forms in the veins of the legs will travel through the heart chambers on the right side of the heart (where venous blood returns). The right side of the heart pumps blood to the lungs where its oxygenated and returns to the left heart which then pumps t out to the rest of the body.. The clot would lodge in the small vessels in the lungs before it ever made it back to the left heart circulation that supplies the coronary vessels. It's called a pulmonary embolus.. and, while fatal, it's not even close to what happened to Russert.

    Nice try with the conspiracy theory nonsense... but this is exactly the kind of ignorance that fuels public suspicion and further ignorance.

    If you don't know what you're talking about, then maybe... don't talk? Seriously.

    Posted by jflies June 13, 08 11:54 PM
  1. I was saddened to hear about Tim Russert. May I make a suggestion about a possible fund for Tim: In this day and age, when so much is known about heart attack prevention, and when we have surgery for blocked arteries that could have saved Tim Russert, why don't we have regular health screenings for heart blockages in place for all Americans beginning at a certain age? Is this something Tim's family or co-workers would be willing to campaign for? Let's not see Tim die in vain for something that could have been prevented.

    Posted by Elizabeth June 14, 08 12:54 AM
  1. I hear you jwood. I told my wife I was wondering about that too. It may be a coincidence, but his trip to and from Italy may have helped hasten a heart attack. I am not a medical specialist either, but I know people can get deep vein thrombosis from long plane rides. We may never know for sure, but it does makes you wonder if this would have happened so soon he had not traveled halfway around the world. I didn't know him, but from what I saw in his public life and what others say about him, he seemed like a great guy. He was my favorite political journalist on TV. My prayers go out to his family.

    Posted by Marko June 14, 08 02:45 AM
  1. jwood. I was thinking of the exact same thing. Also from watching the coverage on msnbc etc. it appears as if Tim lead a very full, busy life which from accounts he cherished. Maybe living this full live to the extreme. (Good for him!) Sounds like he worked 24/7 and enjoyed every minute of it. Jack Welsh told a telling story of Tim driving hours to Boston recently dropping off a truck for his son to pack up from BC, then giving a speach and heading right back to Washington for wok. He lived a fully, busy, meaningful and giving life some everything that I've heard said. God speed to you Tim and may you know be comforted in the loving embrace of Christ whom you loved. Smile when you think of him.

    Pax,
    rmmp

    Posted by rmmp June 14, 08 04:19 AM
  1. I think that jwood makes an excellent observation. I hope that Big Russ got to say goodbye to his brilliant, annoying son. And, Luke- a happy celebration turned tagic.
    I cannot imagine the pain that the Russert family is feeling on Fathers Day Weekend.
    It is sad and a great loss, even to me a Republican and a Fox News devotee.

    Posted by Robert Peterson June 14, 08 04:27 AM
  1. I doubt he had deep vein thrombosis, which is what can be caused by long periods of sitting. They are reporting a heart attack. DVTs an lead to pulmonary embolism. I don't think it leads to a heart attack.

    Posted by seltzer June 14, 08 06:34 AM
  1. What part does stress play in a heart attack? It was not part of the list of risk factors.

    Posted by jgerber June 14, 08 06:45 AM
  1. I HEARD CONFLICTING REPORTS THAT MR RUSSERT HAD AN UNREMARKABLE STRESS TEST JUST 2 MONTHS AGO YET PRELIMINARY AUTOPSY RESULTS SHOW CORONARY ARTERY DISEASE AND BLOCKAGES. IF THIS IS TRUE THEN WHY DIDN'T THE STRESS TEST REVEAL THESE ABNORMALITIES.

    Posted by KAREN June 14, 08 07:44 AM
  1. I am saddened by the sudden loss of Tim Russert...I wonder what medical intervention/s he has had in the past...
    I just heard on TV that his death was caused by a cholesterol plaque that loosened from the artery wall that killed him...
    My heart goes out to his family and we have lost such a great commentator
    as Tim has been for many years...
    My heartfelt saddness is felt today for all his co-workers and most of all his dear son and wife ...

    Posted by C.D'Auria June 14, 08 07:58 AM
  1. the type of clot formation you are referring to would affect the venous not arterial circulation and therefore would not cause a heart attack. However, if a clot formed, there would be the risk of a pulmonary embolus or lung clot which can also be fatal.

    Posted by mike miller June 14, 08 09:29 AM
  1. I don't know for sure about that, however taking aspirin before an air flight is absolutely necessary. It's actually very easy to prevent clots by this method.

    Posted by Liz Hoffmann June 14, 08 10:47 AM
  1. Karen,your anguish is justified! Most people(and doctors) don't understand what a stress test tells you. It tells you that at THAT moment you do not have a fixed flow limiting stenosis(blockage) in your coronary artery. It does NOT predict the so called "vulnerable" plaque that becomes disrupted and causes a sudden thrombosis causing the artery to abruptly close and lead to the electrical abnormality that causes the heart to fibrillate. In point of fact most heart attacks(myocardial infarctions) do not result from a flow limiting blockage that is detected by a stress test. We need more tools to detect the patient who is at risk to have this type of tragic event. The cardiology community is well aware of this and is working to develop these tools----and educate care givers!

    Posted by Robert J. Wey,MD FSCAI June 14, 08 01:28 PM
  1. Vunerable plaques in arteries can burst and cause sudden fatal heart attacks.
    Tim may have had one. People who have these plaques are asympotomatic. They are very difficult to diagnose

    Posted by annie June 14, 08 03:40 PM
  1. Russert was a doll. No matter what side of the politcal spectrum a person is on, he was beloved for his great work and genuiness . My respect and admiration of him was validated when he came out with his book: Big Russ and Me. He really saw first-hand what is meant by the "greatest generation" and showed his appreciation for his dad in such a public way. God bless him.

    Someone here said to imagine if this (sudden death) were happening to women, imagine the fallout...well, it DOES. Heart disease is also the #1 killer of women in the U.S. The problem is, the vast majority of medical studies are done with men as the subjects. The problem is, women's heart attack symptoms are often different then men's. Women have been largely ignored in heart research. Since we make up more than 50% of the population, it seems prudent to include female subjects in such research.

    Posted by Erin Newman June 14, 08 04:59 PM
  1. stress, lifestyle, and who knows what excercise he missed due to schedules and press issues that may have contributed. i thought he seemed to have that famous pear shaped symmetry. one dynamic, vital, and truthful seeker of a better world has been given to God. his decisive and clear intellect made his news worth watching. he will be missed!

    Posted by Pete Krohn 06375 June 14, 08 05:34 PM
  1. These kinds of articles confuse but do not help. There two main ways to die from heart disease - one by restricted blood flow to the heart muscle which is a "true" heart attack. To die from this, you have to kill off enough heart muscle so it can no long pump enough blood to keep you alive. The other way is by electrical disturbance of the heart, which is the most electrically self-active muscle in the body having its own built in timing mechanism. Disturb this electrically regular process, a condition known as arrhythmia, and you can die really fast because blood circulation chokes off immediately. The difference? True hearts attacks allow hours to get treatment and to live in those cases, fatal arrhythmias permit but a few minutes. A complication of a true heart attack can be an induced arrhythmia.

    Posted by Robert DuWors June 14, 08 06:56 PM
  1. My respects and sympathy goes to his family and to America, yes to America because all of us are saddened and in shock with this terrible news.
    My analogy would be: the trip to Italy, the food (starches), the olive oil (lubricant) and red wine.
    Well, I heard that consuming extra virgin oil helps with clearing of the cholesterol from the veins; if the news said his death was caused by a cholesterol plaque that loosened from the artery wall killed him, maybe a coincidence but, depending what kind of food he usually consumed, this trip might have been the cause of his demise

    Posted by Erick Vonl June 14, 08 10:14 PM
  1. I've heard about the same thing in news reports about heart attacks after long plane rides, over six hours. I don't think it's something to overlook, but Tim's unfortunate death will definitely help the news networks sell cholesterol lowering drugs and other "anti heart disease" drugs to their sponsors.

    Get outside for a half hour each day and walk around your neighborhood. Shoot some baskets, jump up and down a few times. Lift two barbells several times a week. Drink alcohol, cut back on fast foods. Don't sit for more than 2 hours. Stretch. Eat green leafy veggies. Stop smoking tobacco. have fun in your life. Avoid daily confrontations. Your job sucks? quit, and start again. You'll love your life and discover something new. DO IT

    Posted by stephen douglas June 15, 08 06:30 AM
  1. He did his job well. I will miss him, I watched him on Sundays before I get ready for church, God bless him.

    Posted by Anita Taylor June 15, 08 11:28 AM
  1. The instantaneous formation of clots in the coronary arteries is very poorly understood.

    Posted by Peter June 15, 08 12:25 PM
  1. I am sorry for what has happened, and he worked on his job well. as i admire him.
    Gob be with his his family,and God bless him.

    Posted by Doudi Zeinni January 28, 09 11:12 AM
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Elizabeth Cooney is a former health reporter for the Worcester Telegram & Gazette, where she also was a business reporter and an editor. Earlier in her career, she edited medical books and journals at Little, Brown, and worked for Boston magazine.

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