Television journalist Tim Russert’s sudden death from a heart attack shocked us.  He was aware he had a heart condition and supposedly was doing all the right things.  He even recently “passed” a stress test.

So, what happened and why?

Russert’s fatal attack was caused by a sudden coronary thrombosis – an artery-blocking clot that occurred when cholesterol plaque broke loose.  Blockages caused by plaque rupture are very different from the readily-visible coronary artery blockages routinely treated with stents or bypass surgery.

Plaque ruptures can happen when plaque builds up on the inside wall of the artery.  A lipid core, containing fatty substances, forms and a fibrous cap covers it.  If that cap is thin and inflamed, it can rupture at any time.  Then the cholesterol inside the core spills into the bloodstream.  Once the cholesterol comes into contact with platelets, the platelets clump and block the arteries, causing a heart attack.

This condition is sometimes referred to as “silent heart disease” because it has no symptoms.  Half the population who have heart attacks experience no symptoms before their attack.  

There are positive steps to try to prevent it:

* Know your family history.  Genetics play a big factor in whether or not you’re going to have heart disease.  Let your health care professionals know about your family history.

* Eat right and exercise.  Everyone, whether you have a family history or not, benefits from proper diet and adequate exercise.  There are many resources available to guide you.

* Follow all of your doctor’s advice.  Realize that even if you have passed a stress test, you still could have vulnerable plaque.  Also, accept that if you’ve had a stent or bypass surgery, you are not cured; you are treated.  Be vigilant in following your doctor’s directives for self-care.

* Take all of your prescribed medicines.  Statins, aspirin, clopidogrel (the generic name marketed as Plavix), Angiotensen Converting Inhibitors (ace inhibitors) and beta blockers often are prescribed together as a kind of “cardiac cocktail.”  These work together to lower cholesterol, stabilize plaques, reduce inflammation and inhibit platelet activation.

* Listen to your body.  If something doesn’t “feel” right, check with your physician.  Don’t stop seeking treatment until you are satisfied that you’ve been listened to and properly cared for.