Better Understanding How Tim Russert Died, How to
Avoid It Causing Senior Citizen Buzz
Many older Americans puzzled how newsman passed
stress test and then died shortly after of heart attack
By Tucker Sutherland,
editor & publisher, SeniorJournal.com
June
17, 2008 The death of Tim Russert was a shocker to the world and the
cause of his death heart attack - shortly after passing a stress test,
has left many senior citizens scratching their heads. Seniors, more
sensitive to news about heart attack deaths than most, have been a buzz
about the mystery. A better understanding may come from looking at a
report on a new gadget approved by the FDA in April that tells us more
about the killer plaque laying in wait inside our arteries and a
statement issued yesterday by the CEO of the company that makes it.
"It was not possible with conventional medical
tests to detect the problem in advance," says James E. Muller, MD, CEO,
InfraReDx Inc.
"There are extensive efforts underway to develop
new tools for the detection of cholesterol plaques, and new preventive
therapies."
Russert, NBC News Washington bureau chief and the
moderator of Meet the Press, died last Friday after a sudden heart
attack at the bureau, NBC News said. The 58-year-old was one of the most
popular men on television and one of the most influential in the world.
Heart attacks (myocardial infarction) are the
leading cause of death for both men and women all over the world.[
Russert's long time friend and physician, Dr.
Michael Newman, said that he had asymptomatic (not showing indications)
coronary artery disease that was controlled with medication and exercise
and that he had performed well on a stress test in late April.
Newman, said Russerts death was caused when
cholesterol plaque ruptured in an artery, causing sudden coronary
thrombosis.
Cause of Death
(Note: hyperlinks below are to references at
Wikipedia.com)
Basically, it has been explained that Russert was
able to pass the stress test because the cholesterol plaque was not
thick enough to block the blood flow. The plaque was most likely a long
thin layer on the inside of the artery that began to break free and
cause the clot.
Sudden cardiac death refers to
natural death from cardiac causes. The most frequent underlying
cause of sudden cardiac death is
coronary artery disease. The phrase sudden cardiac death is a public
health concept incorporating the features of natural, rapid, and
unexpected. It does not specifically refer to the mechanism or cause of
death.
A news story published in SeniorJournal.com just
last April may provide a better understanding of this challenge.
Nearly a million Americans - mostly senior
citizens - will suffer a heart attack this year and about half will die.
The odds may swing in a more positive direction, however, with the Food
and Drug Administration's approval today of the marketing of a device
that a doctor can use to see inside a blood vessel to assess the fat
content of the plaque which builds up on the wall of the coronary
arteries, reported SeniorJournal.com. (See link in sidebar,)
Plaque, which accumulates on the artery wall, is a
deposit made up of cholesterol-rich fat, calcium, and other substances
found in the blood.
The LipiScan device, approved April 29 by the FDA,
uses near-infrared spectroscopy to identify lipid core containing
plaques of interest in the coronary arteries in patients already
undergoing cardiac catheterization.
Such plaques, which cannot be detected by
commonly-used tests such as a treadmill examination and even coronary
angiography, are suspected to be the cause of most sudden cardiac deaths
and non-fatal heart attacks.
Many heart attacks occur when a fatty coronary
plaque ruptures, forming dangerous blood clots. Pathologic studies of
patients who died from heart attack have identified a large lipid
(fatty) core among features of coronary artery disease that were
associated with plaque rupture and thrombosis (blood clots).
Research is currently underway to determine how
plaques that are prone to rupture can best be identified before they
cause a heart attack.
This is the first device that can help assess the
chemical make-up of coronary artery plaques and help physicians identify
those plaques with lipid cores, which may be of particular concern,
said Daniel Schultz, M.D., director of the Center for Devices and
Radiological Health.
The InfraReDx LipiScan NIR Catheter Imaging System
uses infrared imaging to detect lipid core-containing plaques of
interest and assess a patient's coronary artery lipid core burden index.
The device works by placing a catheter equipped with a fiber-optic laser
light into the artery. The device shines the near infrared light
delivered through the blood to the artery wall, and measures the light
reflected back from the artery wall, a technique called spectroscopy.
The reflected wavelengths vary depending on how much fat and other
substances are in the plaque in the illuminated portion of the wall.
LipiScan is manufactured by InfraReDx Inc. of
Burlington, Mass. The device is cleared for use by physicians who are
evaluating patients with symptoms of coronary heart disease during a
heart test known as cardiac angiography, to help in detection of plaques
that have lipid (fatty) cores.
It may not have been the precise instrument to
detect the danger that lurked in the artery of Tim Russert but it is
helping move us in the right direction.
Below is a statement issued yesterday by the Dr.
James E. Muller, CEO of InfraReDx that provides a better idea of where
we need to go to prevent future deaths from the cause that led to the
loss of one of the worlds most respected newsmen.
Statement by Dr. Muller
The status of development of novel methods to
prevent sudden cardiac death due to rupture of cholesterol plaques
James E. Muller, MD, CEO, InfraReDx Inc.
June 16 2008 - The sudden death of Tim Russert of
NBC news is a public reminder of the many tragic deaths caused by
coronary artery disease. Each year in the United States approximately
300,000 individuals die suddenly of coronary disease -- over 800 others
died of this disease on the same day that the nation lost its brilliant
commentator and journalist.
The cause of death, in retrospect, is not
mysterious.
Dr. Michael Newman, the physician of Mr. Russert,
has stated that the death was due to a heart attack. The heart attack in
turn, was caused by a thrombus in the left anterior descending coronary
artery, identified by an autopsy, that blocked the flow of blood to the
heart muscle. Dr. Newman stated it is likely that the thrombus resulted
from rupture of a plaque that was rich in cholesterol.
While hindsight provides a clear view, it was not
possible with conventional medical tests to detect the problem in
advance.
Dr. Newman reported that Mr. Russert, who had a low
HDL (good) cholesterol, and was known to have some degree of coronary
atherosclerosis, passed a stress test in April, 2008. The successful
performance on a stress test indicates that Mr. Russert did not have
fixed blockages in his artery.
Unfortunately the stress test was not able to
identify a dangerous plaque hidden in the wall of the artery. As
reported by Dr. Newman it is highly likely that a cholesterol plaque not
detectable by conventional tests was present in the artery.
Even coronary angiography, in which blood flow
through the vessels is directly visualized, would not have been able to
find such a non-obstructive plaque. Conventional therapy, which Mr.
Russert was receiving, was not able to stabilize this plaque and prevent
his death.
There are extensive efforts underway to develop new
tools for the detection of cholesterol plaques, and new preventive
therapies.
The first need is for a non-invasive screening tool
to identify individuals in the high risk population (such as Mr. Russert)
who are in need of more extensive testing. There have been major
advances in the development of non-invasive multi-slice computed
tomography (MSCT). These devices, which require the use of a contrast
agent and exposure to radiation, can now deliver excellent pictures of
both the lumen and the wall of the coronary artery. MRI has also shown
promise. It is likely that non-invasive devices will be able to identify
vulnerable patients with a high probability of having a lipid-rich
cholesterol plaque.
The second need is for a more precise technology
that can confirm preliminary non-invasive findings that a cholesterol
plaque is indeed present. Intracoronary catheters utilizing ultrasound,
spectroscopic and optical measurement techniques have been developed for
this purpose. Studies are in progress to determine if the signs of a
cholesterol plaque detected by the non-invasive measures can be
confirmed by these more precise invasive measures.
The third need is for more effective preventive
therapy. While it is not reported what medications Mr. Russert was
receiving, it is likely that this event occurred despite the use of
statin therapy, aspirin, and anti-hypertensive medications. Research is
being conducted on novel pharmacologic agents and the development of
stents that might have a favorable risk-benefit ratio for stenting of
cholesterol rich vulnerable plaques.
While three building blocks of a potentially more
effective preventive strategy are already in clinical use MSCT,
intravascular diagnostic methods and stents the approaches are not
individually validated for primary prevention of sudden death. Nor is
their use together in a screen, confirm and treat strategy tested.
The unfortunate loss of one of our leading national
figures has occurred before a more effective preventive strategy could
be developed, but an improved preventive therapy for our leading cause
of death may not be far from realization. The loss of Tim Russert, plus
the continuing deaths of so many others, supports the need for
accelerated efforts to test these novel individual approaches and their
combined use in a comprehensive strategy for prevention of sudden
coronary death.
June
17, 2008 The death of Tim Russert was a shocker to the world and the
cause of his death heart attack - shortly after passing a stress test,
has left many senior citizens scratching their heads. Seniors, more
sensitive to news about heart attack deaths than most, have been a buzz
about the mystery. A better understanding may come from looking at a
report on a new gadget approved by the FDA in April that tells us more
about the killer plaque laying in wait inside our arteries and a
statement issued yesterday by the CEO of the company that makes it.