Tim Russert: A possible scenario

Most are familiar with the story of Tim Russert, long-time host of Meet the Press. Russert died following a massive heart attack after having a completely normal stress test two months prior to his death. So, what possibly happened?

An autopsy revealed a fresh clot blocking an artery. Sadly, Russert is a perfect example for a scenario that happens in so many.

Here's the situation. Most massive heart attacks begin silently 5, 10 or even 20 years prior to the heart attack or stroke occurring. What we now understand is that many heart attacks and strokes occur as the result of plaque rupturing, creating a clot that then blocks the artery. The result is the destruction of the heart muscle or brain tissue, respectively.

The most dangerous plaque begins as a tiny boil or pimple. It forms as the result of LDL cholesterol moving into the wall of the artery where it attracts white blood cells or pus cells. The LDL movement is made worse by diabetes, high blood pressure, high triglycerides and smoking. The pus produces inflammation and may cause a high c-reactive protein. This tiny collection of pus and cholesterol ruptures into the artery causing a blood clot.

Often times this blood clot is not enough to block the artery. But, it is like playing vascular Russian roulette. If you keep pulling the trigger, sooner or later, you may find a cylinder with a bullet in it.

Each one of these ruptures produces a small dot of calcium on the wall of the artery.

Today, there is a test known to identify your calcium score. This quick, non-invasive Cardiac CT scan can quickly identify the number of plaque ruptures an individual has had, and is an excellent predictor of whether you may be a candidate for a heart attack.

Incidentally, 10 years prior to his death, Russert had a calcium score of 200. Since each calcium rupture identified on the CT scan is worth 5 points, we can assess that Russert had approximately 40 plaques that had ruptured - ten years prior to the fatal rupture.

The good news is that aggressive medical therapy treatment of blood pressure, LDL cholesterol triglycerides and diabetes can dramatically stabilize plaques so that they do not rupture, thus avoiding a heart attack or stroke.

HMG vascular medicine specialist William Bestermann, MD, who has recently been elected the president for the nation's leading Consortium of Southesast Hypertension Control's (CoSEHC) Cardiovascular Center of Excellence program, has received national recognition for his innovative contributions in reducing cardiovascular mortality.

Talk with your HMG primary care provider to schedule a Cardiac CT ($99.00) to determine your calcium score. You may also call (423) 857-2790 to request an appointment with Dr. Bestermann.