TICKING BOMB TICKING BOMB Tim Russert's heart disease erupted in a fatal chain reaction. Here's what his doctor says happened: 1. Russert had been diagnosed with asymptomatic coronary artery disease, meaning the narrowing in the blood vessels that fed his heart did not cause significant pain or discomfort. His relatively common form of heart disease was being controlled with medication and exercise. 2. When a piece of cholesterol plaque ruptured inside the left anterior descending artery, it lodged in the vessel that is often called "the widowmaker" and blocked blood flow to much of the left ventricle, the heart's main pumping chamber. 3. The sudden coronary thrombosis, as the blockage is called, caused the heart's electrical system to shortcircuit, creating a chaotic electrical storm known as ventricular fibrillation. In V-fib, the heart quivers and does not pump blood to the rest of the body and, most important, the brain. 4. Fire and emergency crews arrived on the scene three minutes after 911 was called and delivered shocks with a defibrillator. But Russert was not revived. Sources: Michael Newman, Russert's personal physician, on CNN; American Heart Association; USA TODAY research by Bob Davis RISK FACTORS AND GUIDELINES RISK FACTORS AND GUIDELINES The risk of a heart attack rises for men after the age of 45 and women over 55, says cardiologist Sidney Smith, of the University of North Carolina, chairman of the American Heart Association and American College of Cardiology committee on guidelines for treating cardiovascular disease.



"Men in their late 50's and early 60's are at an age where a heart attack is a problem they need to be concerned with," Smith says. "If they have risk factors -- high blood pressure, high cholesterol, diabetes, history of smoking, excess weight -- the risk goes higher. "



Unfortunately, Smith says, for all of medicine's success at identifying heart attack and cardiac arrest risk factors, the science still falls short at predicting when trouble's "just around the corner." He says it's impossible to figure out what happened in Russert's case without knowing more about Russert's medical history and risk factors for heart disease.



Smith says that current CPR guidelines say that rescuers who are not trained in rescue breathing should concentrate on chest compressions, which help circulate blood to the brain and thus keep the victim alive until paramedics arrive. Trained rescuers should apply both to oxygenate the blood and keep it flowing.



By Steve Sternberg, USA TODAY TIM RUSSERT TIMELINE TIM RUSSERT TIMELINE 1950: Born in Buffalo, N.Y. Eventually graduates from Canisius High School, John Carroll University and with honors from the Cleveland-Marshall College of Law.

1977-1982: Aide to the late senator Daniel Patrick Moynihan of New York.

1983-1984: Counselor in the New York governor's office in Albany.

1984: Joins NBC News.

1985: Supervises NBC's Today program's live broadcasts from Rome, negotiating and arranging an appearance by Pope John Paul II, a first for American television.

1986 and 1987: Leads NBC News' weeklong broadcasts from South America, Australia and China.

1990: Oversees production of prime time special A Day in the Life of President Bush.

1991: Becomes managing editor and moderator of Meet the Press.

1993: Oversees production of A Day in the Life of President Clinton.

1994: Senior vice president, Washington bureau chief, NBC News. Also anchors CNBC's The Tim Russert Show.

2004: His book, Big Russ and Me: Father and Son - Lessons of Life, is a New York Times No. 1 bestseller.

2005: Wins an Emmy for his role in the coverage of the funeral of President Reagan. 2006: His second book, Wisdom of Our Fathers: Lessons and Letters from Daughters and Sons, is also a New York Times No. 1 bestseller.



Source: Who's Who in the Media WIDESPREAD PROBLEM WIDESPREAD PROBLEM Prevalence of cardiovascular diseases in American adults: Age 20-39

Men: 14.8%

Women: 9.4% Age 40-59

Men: 39.1%

Women: 39.5% Age 60-79

Men: 71.3%

Women: 75.1% Age 80 and older

Men: 83%

Women: 92% Source: National Health and Nutrition Examination Survey, 1999-2004. For all their differences, NBC newsman Tim Russert and famed marathoner Jim Fixx, author of the 1977 best-seller The Complete Book of Running, have two things in common: Each died of a massive heart attack while still in his 50s. Neither one saw it coming. Russert, 58, died Friday while recording voice-overs for Meet the Press, anchored, as usual, to a desk. Fixx, 52, died on July 20, 1984 after a daily run in rural Hardwick, Vt. Such cases provide tragic proof that though you can lower your risk of sudden death, you can't always prevent it, says Robert Califf, vice chancellor of clinical research at Duke University in Durham, N.C. WHAT'S NEXT?: How will 'Meet the Press' press on? IN APPRECIATION: Former boss remembers a reluctant TV star TRIBUTE: Praise from both sides, competitors "Jim Fixx had multivessel coronary disease he couldn't do anything about, no matter how many veggies he ate or miles he ran," Califf says. "Wearing a seat belt doesn't guarantee you aren't going to get killed in a car crash." Russert's death is a wake-up call to thousands of men who never thought they might be courting a coronary, says Cam Patterson, chief of cardiology at the University of North Carolina-Chapel Hill. "You wouldn't believe the calls we've been getting," Patterson says. "Here's an example of a high-profile person who everyone thought was healthy. When someone like that has a medical catastrophe, it causes everyone to focus." Warning signs Both men had ample warning they were prime candidates for heart attacks. Russert had been diagnosed with coronary artery disease, his doctor told MSNBC. Fixx had a terrifying family history, including a father who had a fatal heart attack in his early 40s. And both took steps to reduce their odds of the same fate. Russert's doctor, Michael Newman, prescribed medication and exercise. He told MSNBC that Russert performed well on a stress test in April. Fixx, who reached the height of his fame before cholesterol-lowering drugs were widely available, changed his diet, laced up his running shoes and ate up the miles. Russert's death seemed all the more shocking for the era in which it occurred, one of rising optimism about potent cholesterol-lowering drugs and decreasing death rates from heart disease. Just over a year ago, a team led by researchers at the Centers for Disease Control and Prevention reported that the death rate from heart disease in the USA has dropped by 50% from 1980 to 2000, thanks to improvements in medical treatment and a reduction in risk factors. The researchers credited those advances — including intensive cholesterol-lowering and blood pressure control for heart attack patients and a drop in smoking rates — with saving an estimated 341,000 lives that would have been lost to heart disease if conditions in 1980 had persisted. For all those advances, however, medical science still has no definitive way to tell in a given individual when "something's just around the corner," says cardiologist Sidney Smith at UNC. The different tests at doctors' fingertips provide varying amounts of information but not, typically, what doctors and patients most want to know. For instance, a routine stress test, performed using a combination of a treadmill and electrocardiogram, can disclose heart rhythm abnormalities that occur during exercise when blockages prevent the heart's blood supply from meeting its growing demand. Nuclear and ultrasound stress tests produce cloudy images and information on heart function. CT heart scans, a series of rapid-fire X-rays, reveal calcified blockages in the coronary arteries. None reveals an imminent heart attack. The best indicators, Califf says, are standard risk factors for heart disease: blood pressure, cholesterol, smoking, diabetes, stress, diet, exercise and abdominal obesity. Reliable, not perfect, data Plugged into a formula called the Framingham Risk Score, the risk factors provide reliable odds of a person's heart attack risk. The odds are derived from real world experience — an ongoing, 60-year-old heart study among thousands of residents of Framingham, Mass. But the Framingham score is imperfect, too. Half of all heart attacks occur in people who have no risk factors and 20% in people with no major risk factors. The reason lies in the biology of the coronary artery. In landmark research, Steven Nissen of the Cleveland Clinic has shown that when cholesterol begins collecting in artery walls, it pushes them outward, not into the channel where blood flows. So many patients — Russert included — experience no symptoms of heart disease. Heart attacks occur when a plaque becomes inflamed and bursts, sending blood clots and debris downstream to lodge in arteries supplying the heart. Standard diagnostic tests don't reveal these inflamed cholesterol deposits or plaques. Over the past few years, researchers led by Paul Ridker of Harvard have shown that testing for a chemical signal of inflammation, called C-reactive protein, or CRP, can add predictive power. But many heart attacks are still unpredictable. Russert's is a textbook example. Making positive changes UNC's Patterson says allowing fatalism to grow out of the uncertainty is the wrong thing to do, because you can dramatically reduce the odds that you'll be next by reducing the risk factors. "I try to eat well, avoid fatty foods, eat seafood a couple of times a week," he says. "I don't smoke. I have a regular exercise regimen. I run three or four times a week. I try to build it into my lifestyle." Not making such practices a permanent change is "a big mistake people make," he says. "It needs to be the thing you do on a daily basis. "If there's one key message I try to get home to people, it's this," Patterson says. "There's great news. Over the last 30 years, we've substantially reduced deaths from heart disease in the U.S. "But it's still the leading cause of deaths and disability. Half the people who are walking around are going to die at some point of heart disease." Enlarge By Charles Dharapak, AP Tim Russert speaks in November 2007 at the 60th anniversary celebration of Meet the Press at the Newseum in Washington. Russert took steps to decrease his risk of heart attack, but he collapsed and died at work on June 13. 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