Goodbye, Mr. Russert

Tim Russert died suddenly today. I admired his journalism, his ability to press questions that has become so rare. He didn’t seem to suffer from the “two-side-ism” that has become so common in today’s journalism; he realized that some issues don’t have two valid opposing views. But others will eulogize him. I’d like to talk about why he died.

Of course, we don’t know very much at this point. What we do know is that it was sudden.

There are a number of reasons for someone to suddenly drop dead, the most common having to do with the cardiovascular system. Pulmonary embolism and massive stroke can sometimes present as sudden death. A common cause, though, is a clinical entity known as “sudden cardiac death” (SCD) .

Sudden cardiac death is very common, killing around 300,000 Americans every year. Most of these people are found to have underlying coronary artery disease. Other causes include hypertrophic cardiomyopathy (seen in young people), and various inherited heart rhythm disturbances, such as long QT syndrome.

Sudden cardiac death, by definition, happens quickly. The person experiences little warning, goes down, and dies. There is no lingering. Still, the proximity and availability of emergency care can make a difference. Automated external defibrillators (AEDs) are becoming more common, and can save lives if used immediately.

Most SCD is due to underlying coronary artery disease. How does this lead to sudden death?

Usually, SCD is caused by a fatal arrhythmia, or disturbance in the normal beating pattern of the heart. This can happen for many reasons—previous damage to the electrical system from heart attacks, electrolyte disturbances, drugs and medications, and structural heart problems such as dilated cardiomyopathy.

It is very difficult to save someone from SCD—they must be very lucky and have sophisticated help nearby. So, like most things medical, prevention is very important.

Since most SCD is associated with coronary artery disease (CAD), identification and treatment of underlying CAD can save lives. There are many online tools available to help you evaluate your own risk.

Risk is divided into two categories: fixed, and modifiable. An example of a fixed risk factor is family history. If your father had a heart attack at thirty, you are at increased risk and there’s nothing you can do to change that fact.

The most important modifiable risk factors are high blood pressure, high cholesterol, diabetes (sort of), and cigarette smoking.

We know quite a bit about treating heart disease. A complete evaluation by a primary care physician in an invaluable tool in reducing your risk of heart disease and many other illnesses.

On my old blog I compiled a list of things you should ask your doctor:

  1. What is my blood pressure? Is it OK?
  2. Have I been checked for diabetes?
  3. How is my cholesterol? Is that OK?
  4. Am I due for any vaccinations?
  5. Do I need any cancer screening, such as PSA, colonoscopy, mammogram, pap smear?
  6. How is my weight? What is my body mass index (BMI)?
  7. Here is my medication list–does it match yours?
  8. What is my overall cardiac risk? (e.g. see this link, or this one).
  9. How do I quit smoking?

Tim Russert was a relatively young man, at the height of a remarkable career. Many people who die suddenly leave behind family and friends with no chance to plan for their own deaths. Despite what some of the modern shamans out there might say, my job as an internist focuses very strongly on primary and secondary prevention. Stop by and see me some time.