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Russert case prompts interest in sudden cardiac death

Jun 23, 2008 | Associated Press | Newsday

When Dr. David Brown heard the news of Tim Russert's death, even he was more than a little unnerved.

"I was really upset about it," said Brown, chief of cardiovascular medicine at Stony Brook University Medical Center. "He was only a little bit older than me."

So Brown sat down and penned an article for his local newspaper, discussing sudden cardiac death, the TV journalist's case and how to prevent it.

He's among cardiologists across the area who say appointments are up and patients are calling daily to find out what they should be doing to check their own heart health since Russert died June 13 at the age of 58.

"Any time a celebrity has a medical problem that hits the news, there's a heightened awareness of the condition," said Dr. Stephen Green, chief of cardiology at North Shore University Hospital in Manhasset. "We've been seeing more people coming into the emergency room and scheduling appointments."

Today, heart disease treatment and heart attack prevention are a combination of the age-old mantra - don't smoke, do exercise, maintain a healthy weight, and eat well - and tests and medications that can bolster the system against deadly episodes.

Along with standard tests for heart disease risk, many doctors are turning to an array of new screenings that pinpoint protein markers as a way to get a jump-start on cardiovascular disease and to stop it before it starts.

Some are looking at C-reactive protein, a marker in the blood that indicates inflammation. Blocked coronary arteries are prime examples of inflammation. Experts ranging from those at the American Heart Association to others at the U.S. Centers for Disease Control and Prevention say the presence of C-reactive protein confirms the theory that inflammatory processes are involved in cardiovascular disease. Many medical centers, including those on Long Island, offer testing.

New test for diabetes

Diabetes, a leading cause of cardiovascular complications, also can be identified in new ways. A test that measures sugar in red blood cells can reveal what a patient's blood sugar has been for the past three months. That contrasts with a 24-hour fasting test that can't give a recent blood-sugar history.

An edgier notion - still without a test - is the germ theory of heart disease, which says dental infections may cause heart attacks that can't be explained through conventional measures such as high cholesterol.

As new methods of detecting heart disease are becoming more common, some doctors would like to see one old one ushered out - at least as a predictor of sudden cardiac death.

Brown and Green, for instance, see no benefit in stress testing as a predictor of sudden death risk even though the treadmill has long been a gold standard in diagnosing heart disease. "You can have a stress test" and pass with flying colors "and the next week die of a ruptured plaque," Green said.

Sudden cardiac death killed Russert, even though he had a stress test about a month earlier.

The American Heart Association estimates 850 people succumb to sudden cardiac death daily, a total of 310,000 people a year. According to Dr. Richard Shlosmitz, chairman of cardiology at St. Francis Heart Hospital in Roslyn, it occurs when plaque that has built up in the arteries ruptures, triggering a cascade of chemical events, particularly clot formation. The clot blocks blood flow to the heart and the heart suddenly stops.

Balloon opens blockages

Green advocates wider use of balloon angiography in which a catheter with an inflatable tip is used to open blockages. The procedure also can be modified to leave a drug-coated stent in place, ensuring the obstruction will not come back.

Doctors estimate that 90 percent of adults who succumb suddenly like Russert have two or more major coronary arteries narrowed by fatty plaques. Many have scar tissue from a previous heart attack.

Published reports of Russert's medical and autopsy records suggest he had elevated blood sugar, a thickened heart muscle and extensive atherosclerosis, or clogged arteries. His enlarged heart suggests he also had hypertension.

"Russert had a number of risk factors," Brown said, virtually all of which could have been modified by changes in lifestyle and strict adherence to medications.

To treat one risk factor of heart disease - high cholesterol - Dr. Kirk Garratt, director of interventional cardiovascular research at Lenox Hill Hospital in Manhattan, is enthusiastic about statin drugs such as Lipitor, Crestor and Zocor that lower so-called bad cholesterol.

"Statins have been beneficial for millions of people," Garratt said. "We now have information from large clinical trials that tell us convincingly that statins work for patients with known heart disease and people who have elevated cholesterol but without heart disease.

"So it's hard to argue against giving an at-risk patient a statin drug. Anyone who is at risk of a heart attack should be a candidate. In the American population there aren't many middle-age adults who are not at risk," Garratt said.

For heart disease patients, he often recommends clopidogrel (Plavix), which, like aspirin, prevents clumping of blood platelets, which are key to clotting.

Yet Green said aspirin, the old medicine cabinet standby, also has proven benefits in preventing heart attacks. At only pennies a day, it can be taken by people without a history of heart attacks or strokes, but whose risk increases by virtue of age. A low daily dose at 81 milligrams is usually all that is needed to prevent the formation of a potentially fatal clot.

Even after a clot forms, triggering arrhythmia that can stop the heart, fast action can still save a life.

"If there had been a defibrillator at NBC's Washington bureau, it's possible he [Russert] might not have died," said Shlosmitz. "A layman could have saved his life. Without a defibrillator, even I couldn't have saved him."

ARE YOU AT RISK?

Here are some risk factors for heart disease, and how to work to prevent it.

SMOKING Don't smoke, because it increases blood pressure, increases the tendency for blood to clot and decreases HDL (good) cholesterol. It also is a major cause of atherosclerosis, a buildup of fatty substances in the arteries.

BLOOD PRESSURE High blood pressure is a major risk factor. A level of 120/80 or lower is normal. Lifestyle changes or medication adjustments may help you lower your risk.

CHOLESTEROL Less than a total of than 200 milligrams per deciliter with an HDL (good) cholesterol of at least 40 mg/dL is desirable. You should work with your doctor to reach your cholesterol target, and test it regularly.

DIABETES Exercise and weight control can help prevent adult-onset diabetes. Two out of three people with diabetes die from heart disease and stroke.

OBESITY Lose weight if you are overweight or obese. An adult who has a body mass index of 30 or higher is considered obese. Overweight is a BMI between 25 and 29.9. Normal weight is a BMI of 18 to 24.9. (Go to nhlbisupport.com/bmi/ to calculate your BMI.) The CDC recommends at least 30 minutes of physical activity most days of the week to cut the risk of heart disease.

FOODS Eat a healthy diet low in sodium and saturated fat and high in fruits and vegetables.

ALCOHOL Drink alcohol moderately, no more than two drinks per day on average for men and no more than one drink per day on average for women.

Heart attack warning signs

Chest pain or discomfort that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.

Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

Shortness of breath, with or without chest discomfort.

Other signs may include breaking out in a cold sweat, nausea or lightheadedness

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to have other symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

Stroke warning signs

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

Sudden confusion, trouble speaking or understanding

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss of balance or coordination

Sudden, severe headache with no known cause