James Gandolfini headshot
(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
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.
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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?
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.
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
Q: How common is it for someone in their 50s to have a heart attack?
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?
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 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
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?
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?
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,
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
Q: Why do men often develop and die from heart disease at a younger age than women?
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
American Heart Association says some heart attacks are sudden and
intense - the "movie heart attack," where no one doubts what's
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
•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.
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.