“Tim Russert’s death from a heart attack at age 58 is a stark reminder of our vulnerability to the ravages of cardiovascular disease even in the face of major advances in understanding its causes and how to prevent its consequences. Some 300,000 Americans die of sudden cardiac arrest outside the hospital each year. Russert was one of those who at least was aware that he was at risk.
Russert’s doctor Michael Newman said the tough-questioning but congenial host of NBC’s “Meet the Press” had been under treatment for asymptomatic coronary disease. He was carrying excess weight, Newman observed, but he got regular exercise and he performed well on an exercise stress test in April.
None of that prevented a cholesterol-laden plaque from rupturing on Friday morning. The resulting clot, an autopsy indicated, apparently caused his heart to go into ventricular fibrillation which led to cardiac arrest. The autopsy also showed he had an enlarged heart–a manifestation of coronary disease.”
Wall Street Journal Health Blog
June 13, 2008
Coronary artery disease can take one or both of two forms:
1) Hard plaque - years of calcium plaque build-up in blood vessels cause artery blockage, preventing flow of blood. It is gradual and can be measured with a CT Calcium Score.
2) Soft plaque – non-calcified, the plaque erodes the walls of blood vessels and causes rupturing, suddenly preventing flow of blood. A stress test is completely unhelpful in detecting the risk. A CT Angiogram will detect soft plaque and allow the physician to visualize overall plaque load and its locations.
Tim Russert most likely died as a result of a ruptured aneurysm in an artery containing soft plaque build-up.
Mr. Russert’s personal physician spoke on CNN of his having completed a stress test and being on cholesterol-reducing drugs. Neither (of these traditional measures) was adequate to detect and reduce his risk.
Indeed, to quote two eminent cardiologists:
Sidney Smith … at University of North Carolina Charlotte and past president of the American Heart Association: “Russert’s death underscores a major shortcoming in cardiac prevention: protecting people at immediate risk of a heart attack.”
Prediman K. Shah, director of cardiology at Cedars-Sinai Heart Institute, Los Angeles: “It was a classic episode, the way 80% of cases of sudden cardiac arrest occur.” He wasn’t impressed with the report of Russert’s recent successful treadmill test. Even if a test is normal, “You can still have plaque and be at risk,” he tells us. It wasn’t clear whether Russert had been taking a cholesterol-lowering statin, but even if his LDL, or bad cholesterol, was under control, that wouldn’t assure protection against a heart attack. “Statins do stabilize plaque (and thus reduce chances of rupture), but they haven’t eliminated every heart attack or sudden death,” Shah says. “We have to look for other means.”
Unfortunately, what happened here is common in the medical community. The approach ostensibly is to seek “cost effective” methods in managing patients and to stay within the “standard (‘traditional’) protocol”. Unfortunately, these are inadequate.
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scientahealth on June 25th 2008 in Heart Health