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Tim Russert's sudden death has many seeking heart checkups

By RICK MALWITZ • STAFF WRITER • June 18, 2008  http://www.mycentraljersey.com

NEW BRUNSWICK — Yesterday morning, a 50-year-old man came to the emergency room at St. Peter's University Hospital in New Brunswick complaining of chest pains. There, he was met by cardiologist Dr. Dinesh Singal.

Singal suggested there were certain tests that could be conducted, including a cardiac catheterization.

There was no hesitation with the patient. "The first thing he said was, "Let's do it,"' said Singal of the procedure in which a flexible tube is inserted in the groin area and is worked up to the heart to measure blood pressure, oxygen levels and identify blockages.

In the course of the conversation, the name Tim Russert came up.

"Not only are patients thinking (of the sudden death of the 58-year-old Russert), but it has given us an opportunity to bring up a couple of things," Singal said.

The sudden death Friday of Russert, the popular host of "Meet The Press," has become a national conversation piece.

"This kind of thing scares people," said cardiologist Dr. Abel E. Moreyra, who is affiliated with UMDMJ-Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital of New Brunswick.

"Even if they have a low probability (of heart disease), they are concerned," Moreyra said.

"The people who are coming in are more aware of the issues," said Dr. Jack A. Stroh of the New Brunswick Cardiology Group.

During media coverage of Russert's death it was widely reported that he took medication to lower his cholesterol and blood pressure, exercised daily and passed a stress test in April.

"Tim was a good patient. Are there things all of us as patients could be better at? Sure. But Tim was a good patient," his physician, Dr. Mark Newman, said in a CNN interview.

If there was one obvious factor it was Russert's admitted need to lose some weight.

However, cardiologists interviewed by the Home News Tribune cautioned against reading too much into the "passing" of a stress test.

"There are many features on a stress test that need to be evaluated before you can label it normal," said Dr. Stephen Ocken, an attending physician at Robert Wood Johnson University and a member of Cardiology Associates of Somerset County.

According to Newman, an autopsy revealed that Russert's heart attack was caused by cholesterol plaque rupturing in a coronary artery.

Plaque can accumulate in an artery, and, like a volcano, can suddenly erupt, Moreyra explained.

Once the plaque erupts, blood platelets that typically form clots to stop bleeding from a cut of the skin, form clots around the loosened plaque and block the flow of blood to the heart. Deprived of oxygen from the blood, the heart will cease working.

"Unstable plaque may be in an artery that is barely diseased," Ocken said. "A stress test can't pick that up. An angiogram may not be able to pick that up."

Ocken called Russert "a perfect example" of someone who complained of no immediate symptoms prior to a sudden and fatal heart attack.

From what he learned from news reports, Moreyra surmised, "(Russert) was feeling fine and suddenly one of those plaques ruptured."

Among the symptoms that can alert a patient to danger, said Ocken, are chest pains, shortness of breath, decreased exercise tolerance, fainting or dizziness.

But as the death of Russert illustrated, not all fatal heart attacks are preceded by obvious signs.

About 920,000 Americans have a heart attack each year and 38 percent are fatal, according to the American Heart Association. Half of men and 64 percent of women who die suddenly of heart disease have no previous symptoms.

The main indicator of heart trouble is genetics, according to Stroh. "Weight and diet account for only 25 percent of the risk factor. The other 75 percent is genetics," he said.

It was genetics that, in part, prompted the 50-year-old patient treated yesterday by Singal to immediately agree to have a cardiac catheterization. The patient's father died of a heart attack at the age of 54.

The accumulation of plaque was thought to be a problem with people middle age and older. However, according to Stroh, doctors performing autopsies on soldiers killed during the Vietnam War began finding plaque on people as young as 18.

"In the western civilization — in the United States — people develop this plaque at a very early age," said Moreyra, citing diets high in calories and cholesterol.

The death of Russert, his knowledge of the recent death of a 52-year-old physician and the anxiety of the 50-year-old patient he saw Wednesday, has given Singal the subtle reminder to watch his diet.

Singal, who routinely recorded "Meet The Press" on his TiVo, said he stresses with patients the need for exercise and diet.

Following the well-publicized death of Tim Russert, he said, "patients are accepting that with a much better degree of attention."

Contributing: The Associated Press

Rick Malwitz:

(732) 565-7291;

Rmalwitz@mycentraljersey.com