James Gandolfini: Victim of the 'unfortunate forty'

Heart attack or sudden cardiac arrest, Gandolfini is part of a phenomenon. Photo: Tony Sirico (l.) and James Gandofini (r.) / Wikipedia

WASHINGTON, June 22, 2013 ― James Gandolfini was one of the “unfortunate 40 percenters” for whom the first sign of a heart issue is instant death. While an autopsy ruled the actor’s death was due to natural causes, it is not normal for one to perish from heart trouble at the age of 51.

Some suspected Gandolfini suffered from the same problem that took Meet the Press moderator Tim Russert, which was sudden cardiac arrest (SCA), a condition that may have been from a different issue than clogged arteries. The results can be the same, but at this time, no one has indicated whether Gandolfini had clogged arteries or SCA not related to clogged arteries.

Most heart attacks are the result of clogged arteries, where a blood clot forms on the top of a coronary artery due to a buildup of plaque, fatty lipids, or blocked arteries causing strokes. The clot disrupts blood flow to the heart and can kill the victim very quickly.

However, an SCA is an interruption or change in the electrical impulses that regulate heartbeat, causing what is known as ventricular tachycardia or rapid heartbeat. As with any pump, if a heart pumps too fast, it cannot deliver. Victims of SCA can die within minutes without any warning whatsoever.

Post-mortem studies show most people who die from SCA often have atherosclerosis, or an accumulation of plaque in two or more arteries, and this can disrupt electrical activity. Those with prior heart attacks or heart disease may harbor scarring that can disrupt the electrical signal.

The plaque buildup is caused by the accumulation of bad cholesterol or LDL (low density lipoproteins) that can come from diet with excessive whole milk, eggs, fatty meats, or shellfish. It can also be caused by a genetic predisposition that causes the liver to produce too much lipid (cholesterol), which starts to interfere with arterial function.


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There are good lipids called good cholesterol or HDL (high density lipoproteins) that can protect against heart attack. Some experts believe that HDL can even help remove LDL from the bloodstream.

Cholesterol cannot dissolve in the blood, and it’s the lipoproteins that carry cholesterol through the bloodstream that can cause serious health issues.

Aside from HDL and LDL is a third factor, called triglycerides, or the amount of fat in the bloodstream. LDL, HDL and triglycerides combine to create what is known as total cholesterol.

If you are over 50, have diabetes, heart trouble, are overweight, or have a family history of heart trouble; or if you have high cholesterol or smoke, getting regular blood work is mandatory in order to regularly monitor your HDL, LDL and triglycerides.


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With SCA, the blood test is mandatory as well but drug use, excessive alcohol, or any interruption in the heart’s electrical signal may also cause SCA and it is far more difficult to recover from than an arterially related heart attack.

Gandolfini’s final post-mortem diagnosis has either not been determined or the full information has not yet been released. Either way, this tragic event underscores the importance of having your blood work done on a regular basis to determine where you stand and if you need medications or need to alter your diet to avoid future problems.

  

Paul Mountjoy is a Virginia based writer and a member of the American Psychological Association and the Association of Psychological Science.



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