Actor James Gandolfini – an Emmy winner who starred in HBO's "The Sopranos" – died unexpectedly in Italy on Wednesday. Hospital officials in Rome have confirmed that he suffered cardiac arrest. Gandolfini, who was 51, is survived by his wife, 13-year-old son and 8-month-old daughter.
Cardiac arrest, which occurs when the heart stops beating, affects nearly 400,000 people each year, according to the American Heart Association. Causes of cardiac arrest include electrical disturbances in heart rhythm, heart attacks and other cardiovascular conditions. Though cardiac arrest and heart attacks are different, they're closely linked. Sudden cardiac arrest often occurs after a heart attack or during recovery, and heart attacks increase the risk for cardiac arrest.
U.S. News spoke with Larry Santora, a cardiologist at St. Joseph Hospital in Orange County and medical director of the Dick Butkus Center for Cardiovascular Wellness. Santora explained why heart attacks and cardiac arrest occur and what kind of preventive steps can be helpful. His responses have been edited.
Why do heart attacks occur in younger patients?
Most heart attacks occur when you have atherosclerosis, or plaque in the arteries of your heart. The plaque, which is lining the arteries – which are like pipes – ruptures like a pimple into the opening of the artery. A lot of patients don't have any symptoms until that sudden onset of this rupture. Because even though the artery has plaque, it's not restricting the flow until that minute when the plaque ruptures. Around a quarter million people die of a sudden heart attack each year, and about half are under 65. So Gandolfini's experience isn't that unusual. But you wonder, why did it happen to him? Well, we don't know his risk factors, but he certainly had one: He's been overweight and at times obese.
About half of people who have heart attacks don't have symptoms, or if they do, they don't recognize them. When the artery starts to slowly block up, they may have shortness of breath with exertion, but they'll think: "I'm just overweight, and this is happening because I'm out of shape." Or they may have a burning in their chest when they walk, but they think, "I have indigestion," and mistake the warning signs.
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Is there a way to detect who's at risk for a heart attack?
There's a test that can identify plaque in the arteries. At the Dick Butkus Center, we do ultra-fast CT scans that can pick up coronary calcium, or hardening of the arteries. It's a five-minute test, and we don't inject any dye. When we see a lot of plaque in somebody, even if they have normal cholesterol, we put them on cholesterol-lowering or other medicines that can help prevent a heart attack. We call it a mammogram of the heart.
If you're having symptoms, like shortness of breath, chest pain or exertional fatigue, you should have a stress test because you want to see if you have a severe narrowing that's causing symptoms. We recommend the CT scan for men over 35 and women over 40 who have at least one risk factor – such as family history of heart disease, high blood pressure, high cholesterol, obesity or smoking.
With this test, there's no guessing; you have hardening of the arteries, or you don't. You may have a little or a lot. And then we can make recommendations based on that. Our center is named after Dick Butkus, one of the greatest football players of all time, who had no risk factors or symptoms. He had this scan done 10 years ago and found out he had two totally blocked arteries. He went on to have bypass surgery and is doing fantastic.
I'm pretty sure if Gandolfini had this test – well, I'm not saying it would have saved his life, but if he would have had it four or five years ago, they would have seen significant plaque in his heart. Because whatever happened didn't happen overnight.
What's your best advice on preventing a heart attack?
The No. 1 thing is exercising and keeping your weight down. And then healthy eating: You don't need a low-fat diet, but you do need a healthy-fat diet. Avoid animal fats, and focus on fats from plants and fish, and you'll do fine. Eat a handful of nuts every day, and choose olive oil instead of margarine. And limit your trans fat, which comes from cookies, crackers and chips. It's important to eat healthfully 90 percent of the time, not 100 percent.
[Read: Best Diets for Healthy Eating.]