Detecting and Preventing Heart Attacks
ROBERT SIEGEL, host:
I'm Robert Siegel.
MELISSA BLOCK, host:
I'm Melissa Block, and this is ALL THINGS CONSIDERED from NPR News.
SIEGEL: The death last Friday of Tim Russert has inspired, in addition to many appreciations of him, much discussion about coronary disease - its detection, prevention and treatment. According to Russert's personal physician, Dr. Michael Newman, he died of a heart attack that was caused by a clot that ruptured in his left anterior descending coronary artery. Dr. Newman said that Russert had asymptomatic coronary artery disease. He said that an autopsy revealed that he also had an enlarged heart.
Dr. Newman said that Russert managed his coronary artery disease with medication and daily exercise, and that the host of "Meet the Press" also had passed a stress test on April 29th. Well, joining us now to talk about coronary disease is Washington cardiologist Dr. Stuart Seides. Welcome back.
Dr. STUART SEIDES (Cardiologist): Thank you. Good to be here.
SIEGEL: First, let me start with that last point. If you pass a stress test six weeks before a fatal heart attack, is a stress test any good indicator of heart disease?
Dr. SEIDES: A stress test is a good test for looking at whether there is important obstruction in the coronary arteries at the time the test is done. It has its greatest utility in people who are having symptoms. The stress test is often useful in seeing whether they have obstruction in the coronary arteries at that time. The stress test isn't terribly useful at looking for the presence of plaques - that is, narrowing in the arteries. That is not of sufficient severity to interfere with blood flow at that point in time.
SIEGEL: Is there typically any symptomatic pain or discomfort that would precede a heart attack by a few hours, say, that might be a warning sign?
Dr. SEIDES: Well, of course, in Mr. Russert's case, we will never know. But in those individuals who have events similar to what he had and survive, a very significant proportion of those individuals report that they were not feeling entirely well in the day or two preceding the event. In some cases, they had chest discomfort or chest pressure of some kind. Others just had a sense of unwell. And it may be this latter symptom, this sense of unwell, so to speak, that is a reflection of this inflammatory process that we have come to appreciate is an important part of the precipitation of an acute coronary syndrome.
SIEGEL: Let's say somebody called you up and said, I'm feeling unwell. And indeed, this is a convoluted hypothetical, but it was somebody who was on the road to a heart attack of the sort that Tim Russert had. Is there something one could do in the hours preceding that that would prevent the heart attack?
Dr. SEIDES: Well, I think if one is fortunate enough to capture an individual when they are on the brink of having this kind of event, it is preventable. If one identifies the fact that a person has what we would call an acute coronary syndrome or unstable angina, we will bring them into the hospital, do a coronary angiogram, identify this unstable, ruptured plaque, and be able to do something mechanically to stabilize it before one goes on to have a coronary occlusion.
SIEGEL: Heart attack deaths often lead, nowadays, to discussions of having defibrillators around. What is the rate of actually assisting somebody who is having a heart attack if you have a defibrillator on hand?
Dr. SEIDES: If you have a witnessed cardiac arrest and you have an automatic defibrillator and someone who is willing to use it, there is a chance that he might have been resuscitated and saved.
SIEGEL: This isn't just anecdotal. I mean, there are fewer people who seem to die of heart attacks at very untimely ages like 58, in Tim Russert's case. It just isn't as common as it used to be 20, 30 years ago. True?
Dr. SEIDES: Absolutely. Absolutely. And I think that that reflects a combination of, I think, good public-health measures. We as a society smoke less. We are attentive to the notions of cholesterol and unsaturated fats in a way that generations before us were not. I think we're better at controlling blood pressure and so forth. And, of course, on the medical side, we have tools at our disposal, both pharmacological tools and mechanical tools that have all helped to reduce the incidents, or at least the - let's say the prematuret of death from heart and vascular disease. No question about it.
SIEGEL: Well, Dr. Seides, thanks a lot for talking with us.
Dr. SEIDES: Great to talk to you, too.
SIEGEL: That's Dr. Stuart Seides, who is associate director of cardiology at the Washington Hospital Center.