21 June 2013

Cardiac deaths like James Gandolfini's are too common

 Story Appeared in USA TODAY

The American Heart Association's president talks about how heart attacks can be avoided.

The news that James Gandolfini, 51, star of The Sopranos, died of cardiac arrest stunned his fans, but for medical experts, it was a reminder of the thousands who remain at risk of a similar fate all the time.

Claudio Modini, head of the emergency room at the Policlinic Umberto I hospital in Rome, said Gandolfini suffered a cardiac arrest and was pronounced dead at 11 p.m. Wednesday after resuscitation efforts in the ambulance and hospital failed. An autopsy will be performed. Originally, it was reported that Gandolfini died of a heart attack.

A heart attack may cause cardiac arrest and sudden death. Heart attacks are caused by a blockage that stops blood flow to the heart. Cardiac arrest is an abrupt loss of heart function caused when the heart's electrical system malfunctions. About 360,000 cardiac arrests are assessed by emergency medical services in the USA annually.

About 715,000 people in the USA will have a new or recurrent heart attack this year, according to the American Heart Association. The average age of the first heart attack is 64.7 years for men and 72.2 years for women.

USA TODAY talked to Donna Arnett, the president of the American Heart Association and the American Stroke Association, about the risk of having a heart attack and ways to avoid it. Arnett is chairman of the department of epidemiology in the School of Public Health at the University of Alabama at Birmingham.

The answers below are from both Arnett and the American Heart Association website:

Q: What is a cardiac arrest? Is it the same as a heart attack?

A: No. The term heart attack is often mistakenly used to describe cardiac arrest. Though a heart attack may cause cardiac arrest and sudden death, the terms don't mean the same thing. Heart attacks are caused by a blockage that stops blood flow to the heart. A heart attack refers to death of heart muscle tissue due to the loss of blood supply, not necessarily resulting in the death of the heart attack victim.

Cardiac arrest is caused when the heart's electrical system malfunctions. In cardiac arrest, death results when the heart suddenly stops working properly. This may be caused by abnormal, or irregular, heart rhythms called arrhythmias. A common arrhythmia in cardiac arrest is ventricular fibrillation. This is when the heart's lower chambers suddenly start beating chaotically and don't pump blood. Death occurs within minutes after the heart stops.

Cardiac arrest may be reversed if CPR (cardiopulmonary resuscitation) is performed and a defibrillator is used to shock the heart and restore a normal heart rhythm within a few minutes.

Q: How common is it for someone in their 50s to have a heart attack?

A: Though risk for heart attacks increases with age, it is not uncommon for a heart attack to occur in the early 50s. Data from one study show that for every 1,000 men, ages 45-54, three will have heart attacks every year. This is why it is important for men and women to visit their health professional to be screened for conditions that increase heart disease risk, such as high blood pressure, high blood cholesterol and type 2 diabetes.

Q: Could Gandolfini's weight have contributed to heart troubles?

A: Obesity is a contributor to the risk of heart attack. We know that excess body weight raises blood cholesterol and blood pressure and can induce type 2 diabetes.

Q: What is a heart attack?

A: A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with blood can slowly become narrow from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis.

When plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI). About every 34 seconds, someone in the USA has a myocardial infarction or heart attack.

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