Nanci Hellmich,USA TODAY
The news that James Gandolfini, 51, star of The Sopranos, died of heart troubles 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. CNN, quoting an "Italian official," reported Friday that an autopsy confirmed 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.
Q: What are the major risk factors for a heart attack?
A: There are several major risk factors for heart disease that people have no control over, including your genetics. People whose parents had heart disease are more likely to develop it. Among the other risk factors you can't change: getting older, being male (men are at a greater risk than women), heredity, including race. Heart disease risk is higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly because of higher rates of obesity and type 2 diabetes.
There are factors you can change that lower your risk including - getting up and moving more, not smoking, maintaining a healthy weight and controlling your blood pressure and cholesterol.
Q: Why is high blood pressure a risk factor for heart disease?
A: High blood pressure means the blood running through your arteries flows with too much force and puts pressure on your arteries, stretching them past their healthy limit and causing microscopic tears. Unfortunately, the scar tissue that forms to repair those tears traps plaque and white blood cells, which can lead to blockages, blood clots and hardened, weakened arteries.
One in three adults have high blood pressure, but many people don't even know they have it. The risk can be reduced by following a healthful diet, including cutting back on salt; exercising; keeping a healthy weight; managing stress; limiting alcohol; and avoiding smoking. Some people who do those things may still need medication.
Q: Why do men often develop and die from heart disease at a younger age than women?
A: Men tend to have higher blood pressure and higher cholesterol, and they are more likely to be smokers than women. Men are less likely to be treated for high blood pressure than women. One big problem for men is a lot of them don't manage their blood pressure as well as women do.
Contributing: The Associated Press
How to spot a heart attack
The American Heart Association says some heart attacks are sudden and intense - the "movie heart attack," where no one doubts what's happening.
But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:
•Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
•Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
•Shortness of breath with or without chest discomfort.
Other signs may include breaking out in a cold sweat, nausea or lightheadedness. As with men, women's most common heart attack symptom is chest pain or discomfort. Women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.