Sunday, June 15, 2008

Nagging questions about Russert’s sudden death

The sudden death of Tim Russert from cardiac arrest raises questions that aren't being answered or asked with enough urgency:

  • Why wasn't Russert's enlarged heart -- which his internist said was discovered during the autopsy -- detected while he was alive? Enlarged heart is not necessarily a symptom of coronary artery disease -- which led to the cardiac arrest that killed Russert -- but it is a potential danger sign. It can be picked up with a test as simple as an X-ray.
  • Did the exercise stress test that Russert took in April include either a nuclear scan or stress echocardiography? The scan can reveal “cold spots” on the patient’s heart resulting from diminished blood flow during peak exercise – a potential sign of the kind of arterial blockage that struck Russert’s heart. Echocardiography can detect – again during peak exercise – reduced contractions of heart muscle resulting from blocked blood flow to the left ventricle due to coronary artery disease.

    If Russert's enlarged heart
    had been detected while he was alive, that condition might have prompted more sophisticated tests to determine whether he had serious -- as opposed to "asymptomatic" -- coronary artery disease that would acquire aggressive intervention. One such test is coronary angiography in which a dye is injected in the major arteries. Angiograms can accurately pinpoint arterial blockages like the serious one that triggered Russert's cardiac arrest.
  • Would it have been a sensible precaution for the NBC Studios in Washington, where Russert collapsed in his office, to have a portable defibrillator that might have shocked his heart back to its normal beat?

Dr. Douglas Zipes, past president of the American College of Cardiology and distinguished professor of medicine at Indiana University, said Russert had a classic profile for ventircular fibrillation: "male, age 58, slightly but not terribly overweight," according to WebMed.

Zipes told WebMed that "AEDs [portable defibrillators] should be as common as fire extinguishers."

Defibrillation must be administered within 10 minutes of cardiac arrest -- or it's too late. Russert collapsed shortly after 1:30 p.m. last Friday afternoon. An EMS unit arrived at 1:44 p.m. -- apparently past the 10-minute deadline -- and tried unsuccessfully to defibrillate Russert's heart three times. Further life-saving action at the hospital to which he was rushed also proved fruitless.

The average life for an American white male is 76 years (as of 2006) – 18 years longer than Russert lived. That average includes many males who don’t have the resources to take good care of their health or the will to do so. Russert had access to the best medical and health resources and, judging from his regular exercise regime, was mindful of his health.

Perhaps in coming days, after the shock of Russert's death recedes, there will be attempts to answer the nagging questions. The answers perhaps could be a lifesaver for thousands of males and females who die the same death as Russert did. "Sudden cardiac arrest accounts for 310,000 deaths in America every year, or 850 a day -- more than those caused by breast cancer, lung cancer, stroke and AIDS combined," according to Newsweek.

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