Wednesday, June 18, 2008

NBC Anchor, Tim Russert, Died of Heart Disease Dispite A Normal Exercise Stress Test? ~ Dr. B. Interview

Doc B. returns with comments on heart disease, pharmacological stress tests and the recent unexpected death of Tim Russert.

L.P.: What is the latest on NBC anchor, Tim Russert's sudden death from heart disease?
Doc B: His heart doctor, Dr. Oz was on Larry King. Dr. Oz explained that with heart disease, you can never really tell in advance how to prevent it. What are the odds that Tim could have done something different? Dr. Oz explained that "Of the 450,000 people a year who die of heart attacks in this country, probably half of them never knew they were at risk of a heart attack. It's because the heart doesn't really have pain fibers. In fact, the only reason you ever feel any pain when you're having a heart attack is because the nerves in the heart cross other nerves -- from your chin, your arm or from the chest and the spinal column. And they short-circuit each other out. And that creates this referred pain that in cardiology and cardiosurgery we recognize to be angina."

L.P.: If the plaque is not limiting blood flow is that really such a big problem?
Dr. B: Dr. Oz also explained this issue pretty clearly, "... this is a big wake-up call for a lot of Americans, as well -- is that a lot of the plaques that we have are not flow limiting. And by that I mean they don't cause a limitation on the amount of blood that courses through the veins that go to our heart.... "

L.P. : How did that cause the death of Tim Russert?
Dr. B.: Based on what I have read, Tim had a cardiac arrest. It was probably an acute dissection, rupturing plaque that's causing a blockage of a coronary artery. The temporary blockage caused a heart attack -- a fatal arrhythmia.

L.P. Did they try to save Russert?
Dr. B. Dr. Michael Newman told Larry King that a defibrillator, a heart-shocking device, was unsuccessful in saving Russert. "
L.P.: Can't stress tests determine the condition of a patient's heart?
Dr. B.: After releasing autopsy results, Dr. Michael Newman said Russert had passed a stress test on April 29. He had even worked out on a treadmill the morning of his death.
"Russert, age 58, was known to have asymptomatic coronaryartery disease (atherosclerosis), which resulted in hardening of his coronary arteries," Newman said. "The autopsy revealed an enlarged heart and significant atherosclerosis of the left anterior descending coronary artery with (a) fresh clot which caused a heart attack resulting in a fatal ventricular arrhythmia."

L.P.: Did Russert have any symptoms?
Dr. B.: As I understand it, Russert's stress test on April 29 was "normal." Dr. Newman said. "At a high level of exercise he had no symptoms." Newman said Russert's blood pressure and cholesterol were "well-controlled." see http://www.people.com/people/article/0,,...

L.P. : Which is better, pharmacological stress testing or exercise stress testing?
Dr. B.: Imaging tests are more sensitive than the exercise ECG in the detection of severe (three vessel and left main) disease . . . the sensitivity for severe disease was 93 to 98 percent with planar thallium imaging, stress echocardiography, and SPECT perfusion imaging compared with 86 percent for exercise ECG testing. Furthermore, it you have arthritis or are in poor physical condition, you may not be able to exercise at a high enough level to adequately stress your heart without the pharmacological agent.

L.P.: What is the best nuclear pharmacological stress test?
Dr. B.: The modern nuclear pharmacological testing of choice is rapidly becoming the Adenosine stress test. The test can help determine if there is adequate blood flow to the heart during activity versus at rest. Adenosine does not increase your heart rate. Adenosine dilates blood vessels leading into the heart, increasing blood flow, therefore simulating exercise for patients unable to exercise on a treadmill. It is the fastest acting pharmacological agent and while it may produce symptoms of shortness of breath, within seconds of discontinuing the Adenosine, the symptoms almost always stop.

L.P.: Are there any contraindications to using Adenosine.
Dr. B.: The only major restriction is not to use Adenosine if a patient is actively wheezing with Bronchial Asthma. If the patient is not actively wheezing, most facilities such as the Cleveland Clinic will go ahead and proceed with an adenosine stress test despite the patient having a history of asthma. Some will opt to use a Dobutamine stress test instead if the patient does not have tachycardia (fast heart rate) or hypertension (high blood pressure.) The Journal of Nuclear Cardiology 2007 14:827-34 has reported a new study that 6 minute Adenosine infusion can be safe in patients with mild asthma or COPD. In my opinion, it really is a judgment call for the physician based on his training and experience with no wrong answer.

L.P. What is the best advice to reduce your chance of heart disease?
Dr. B: Exercise. Eat a low fat diet. Keep your cholesterol level low. Keep your blood pressure low. If you have diabetes, keep your sugar levels under control! Have regular check up with your doctor. And, last but not least, do not smoke!

L.P. Thanks, Dr. B.

Disclaimer: This article should not be used as a substitute for medical advise or treatment. As always, if you need medical treatment or advice, immediately consult your physician.

22 comments:

Ron said...

Interesting interview, L.P. Thanks for covering this story. Tim was the best in his business and many will miss him.

Ms Calabaza said...

LP,

thanks for this post. It's so sad when someone that loved life and was as vital as Russert dies so young. Your last paragraph pretty much nails it as far as ways to prevent this from happening and my old man doesn't know it yet but he's on a major diet starting today . . .

Anonymous said...

President Bush and Matt Lauer were at the wake.

Legal Pub said...

I post this on behalf of a reader who sent this to legalpub@legalpub.net

I am a long time reader but first time contributor. Here is my contribution:

CINNAMON helps fight belly fat, helps reduce high blood pressure, high triglycerides and blood sugar! It's true. I have studied test subjects who took small doses of cinnamon regularly. They achieved health benefits including: Better blood sugar control, 25% LOWER triglycerides for patients with type 2 diabetes, and in some cases helped lower LDL ("bad") cholesterol levels up to 27%. I don't want any publicity or any compensation. I just wanted to share this gift with your readers in honor or Tim Russert.

G.N.

Joel A. Brodsky said...

Great article. Now figure out how to get health insurance companies to pay for these tests. Its hard (if not impossible), to get them to pay for any “wellness” testing, let alone the state of the art tests discussed here, (and I am sure Russert had a great health insurance police). And then, even if you can get the tests covered, figure out how to get the doctors paid without having the claims denied for no reason, or having to have the claim denied, re-submitted, re-examined, questioned, and re-submitted another half a dozen times. The leading cause of death in America is not heart disease, it’s the health insurance industry.

Ms Calabaza said...

Mr. Brodsky,

once again, I SO agree with you!

Kate said...

Thanks L.P. for posting the benefits of Cinnamon. I read that recently somewhere and had forgotten the benefits.

Anonymous said...

L.P. you rock. Great coverage of a controversial death. This heart disease in Tim was not detected on an exercise stress test.

Thanks Dr. B. for giving us your opinions.

Anonymous said...

I had a normal stress test and a normal echocardiogram. Two days later, I had a massive heart attack.

Folks, there are no guarantees. Live each day like it is your last!

Anonymous said...

Tim Russert death really shook me up. I am heading for a check up.
Thanks Dr. B.

all worked up in new york said...

High blood pressure (hypertension) rises and falls throughout the day. An optimal blood pressure is less than 120/80 mmHg. When blood pressure is higher than 140/90 mmHg—you have high blood pressure. With high blood pressure, the heart works harder and your arteries take a beating. Your chances of a stroke, heart attack, and kidney problems are greater when you have hypertension.

Prehypertension is blood pressure between 120 and 139 for the top or between 80 and 89 for the bottom. If your blood pressure is in the prehypertension range, it will develop into high blood pressure unless you take action to prevent it.

All Worked Up in New York

Anonymous said...

Kate is smoking hot!

Anonymous said...

But what is her blood pressure?

Brooklyn said...

Looks like the I'm eating cinnamon today and you never know which day IS your last. The brave may not live long lives but the cautious don't live at all.

Anonymous said...

Heart failure can strike fast with little warning. Pulmonary edema usually accompanies the heart failure, but it can come on quickly.

Southern Doc

Anonymous said...

Tim Russert's sudden death is one of the most troubling high-profile deaths in recent times.

Anonymous said...

Too much pasta?

Anonymous said...

I have asthma. I had a dubutamine stress test in Indianpolis and had an allergic reaction which caused me not to be able to breath well for 20 minutes. I thought I was going to die. I later learned that dubutamine has a sulfite in it that asthmatics may be allergic too. I have subsequently under gone 2 Adenonsine stress tests at the Care Group. For me, the shortness of breath with Adenosine only lasted less then 10 seconds and was far easier on my asthma then the Dubatamine.

Anonymous said...

My hearts on fire for Ms. Calabaza!

Don't know if she as had an adenosine stress test but maybe she ought to give some thought to it...

I had one. Was short of breath for 2 seconds then felt great until I got the news I needed bypass surgery.

Anonymous said...

Heart failure does not always show up on ECGs until many hours later. Be careful, folks.

Anonymous said...

Yup, lost a friend during a "normal stress test."

Anonymous said...

Docs cant guarantee life for anyone!