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Tim Russert's Death: Questions, Answers

Get Answers to Questions About Tim Russert's Heart Attack -- And Your Own Risk

Russert's coronary artery disease was said to be well controlled with medication and exercise. Why did his heart attack happen anyway?

Patterson: When we talk about having coronary disease being well controlled, what we usually refer to are the symptoms of chronic blockages. And it's important to remember that chronic blockages are very different from plaque rupture, which is what killed him. He may very well have been treated very effectively to reduce symptoms from the chronic blockages, but we don't have any therapies that specifically prevent plaques from rupturing.

Would he have been a candidate for more aggressive treatment?

Zipes: I'd need to know more about him. For example, if he had significantly reduced heart function -- an ejection fraction of 35% or less -- he would have been a candidate for an implantable defibrillator.

Is it possible that the care he did get actually did prolong his life?

Ostfeld: That's a great point. That's very possible. It's possible that without having his medical problems treated and without having a healthy lifestyle, his heart attack may have been 10 years earlier.

The autopsy showed that he had an enlarged heart. How does that happen, and how might that have played a role?

Zipes: It could be that he had previous heart attacks, and that can then produce scarring and dilation of the heart. A heart attack, in about 10% of individuals, may be asymptomatic, so you have no chest pain associated with that. It's even higher in diabetics, and I read some place that he was diabetic, so he could have had an asymptomatic heart attack in the past. Or he could have had other causes. ... Most commonly, given the autopsy and what happened to him, it was due to the coronary disease.

Does having diabetes make it harder for people to be aware of heart attack symptoms?

Ostfeld: Yes, that's quite possible. Sometimes people can have a "silent" heart attack where they actually had death to part of the heart muscle -- the heart attack -- but did not feel it, and that is reportedly more common in people with diabetes because they may have some nerve damage that may reduce their ability to feel that.

His coronary artery disease was asymptomatic -- that's silent heart disease?

Patterson: That's silent heart disease. It's important to remember that half of people who have heart attacks don't have symptoms before they have a heart attack.

How would someone find out that they have that?

Ostfeld: There are a handful of ways that we can predict future risk and/or specifically screen for atherosclerosis that may not be clinically apparent. Routine screenings are things like cholesterol and high blood pressure and diabetes -- things that, if elevated or present, may significantly increase your future risk of heart disease. Those should be part of routine evaluation.
Other tests include a blood test looking for inflammation in the body; one blood test is a high-sensitivity CRP test. But it is not clear that checking this blood test will always modify how we treat the patient.

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