The death of Tim Russert, a robust man who was only 58, was shocking to so many not only because of his celebrity but because he had few outward signs that he was in danger.
Russert, according to his doctor, had heart disease and was overweight. The massive attack that felled the popular political analyst as he working in NBC's Washington bureau last Friday is a grim reminder that the first signs of heart disease should not be ignored because they can be fatal.
The catastrophic medical event that killed Russert is called sudden cardiac death, a change to the heart that can come on with or without a heart attack.
Russert's physician, Michael Newman, told NBC News that plaque from a clogged artery ruptured, traveled to his heart and blocked it. The result is a quickly cascading chain of events that Russert may not have even felt coming.
Mandeep Mehra, chief of cardiology at the University of Maryland Medical Center, explains that the blockage likely disrupted the rhythm of Russert's heartbeat, sending it into a state called ventricular fibrillation, where electrical signals get confused in the heart and cause it to beat hundreds of times per minute.
"It's such a high heart rate that the heart just starts to quiver and it's unable to pump blood," said Mehra, "You won't be able to pump blood to the brain and you won't be able to pump blood to the rest of the body."
The condition typically causes death in between three and seven minutes, according to Dr. Douglas P. Zipes, director emeritus of the division of cardiology at Indiana University School of Medicine in Indianapolis, and former president of the American College of Cardiology.
Two courses of action may help: CPR or a defibrillator.
Mehra says the best action is to use a defibrillator. When used correctly, the defibrillator sends a jolt of electricity to the heart, correcting the electrical signals and allowing a normal heartbeat to return. Occasionally, CPR can keep the blood flowing until a defibrillator arrives, but the defibrillator is key to survival.
"Had a defibrillator been there and used in a timely fashion, it's possible he could have been resuscitated," said Zipes.
NBC News could not be reached for comment on whether a defibrillator was available in its Washington Bureau.
It is unclear what, if anything, Russert himself could have done to prevent sudden cardiac death. In 30 to 50 percent of the cases, said Zipes, there are no warning symptoms before the ventricular fibrillation.
"There may not be any warning whatsoever," he said
With so few options to help in his last moments, others in Russert's state of health question what could be done to save him from this situation.
In 2005, 16 million people in the U.S. had heart disease. Though many treatments are available from statins, to screening, to diet and exercise regimens, this common disease is a killer.
The U.S. Centers for Disease Control and Prevention reports that about every 26 seconds, an American will have a coronary event, and about one every minute will die from one.
"People think that taking preventive drugs like statins and aspirin can overcome the risk of an unhealthy lifestyle. They can't," says Dr. Sharonne N. Hayes, director of the Women's Heart Clinic at the Mayo Clinic in Rochester, Minn. "These are complimentary efforts."
Dr. C. Noel Bairey Merz, of the Cedars-Sinai Medical Center, agrees. "Clinical trials also show that the lifestyle regimen is about half, so taking pills alone is not optimal," says Merz.
However, while doctors can point to what should have been done, Russert's death upset even seasoned physicians.
"It makes us all feel mortal and it also highlights the natural history of this silent killer and our limited ability as physicians to catch this culprit before it strikes," says Dr. Robert Michler, Surgeon in Chief at the Montefiore Medical Center in New York, N.Y.
Michler adds that the ruptured plaque which killed Russert can occur in patients who only have moderately blocked blood vessels.
"The truth is that this story is a recurring daily event, striking people in their prime and without warning," says Michler.
Joseph Brownstein contributed to this report.