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CNN LARRY KING LIVE
Tim Russert's Heart Attack: Can It Happen To You?
Aired June 16, 2008 - 21:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
LARRY KING, HOST: Tonight, a seat no one can fill, a father and husband no one can replace.
(BEGIN VIDEO CLIP)
LUKE RUSSERT: My mother and I are so grateful and holding up as best we can.
(END VIDEO CLIP)
KING: What didn't doctors know?
Why didn't they see it coming?
Could it happen to you?
Questions everyone is asking. Answers from Tim Russert's own doctor plus other heart Specialist.
Plus, the best medicine in the world is laughter dispensed by the office of Steve Carell.
KING: He gets smart with me next on LARRY KING LIVE. Good evening.
Tim Russert's death has renewed the focus on heart attacks.
How can we know if this will happen us to or a loved one?
With us tonight in Washington is Dr. Michael Newman, Tim Russert's personal physician.
From New York, as well, cardiac thoracic surgeon, Dr. Mehmet Oz.
Here in Los Angeles, Dr. P.K. Shah, the internationally renowned cardiologist and my own heart doctor, as well.
And joining us, as well, in Los Angeles, Amy Yasbeck. She's John Ritter's widow. He died suddenly from a heart-connected problem.
Dr. Newman is an internist and clinical professor at George Washington University.
Dr. Oz, the well-known heart expert, from the New York Presbyterian College. And he's the health expert for Oprah Winfrey. Dr. P.K. Shah is a member of our own advisory board for the Larry King Cardiac Foundation and is the director of the Division of Cardiology and Research Center at Cedars-Sinai.
And Amy Yasbeck is the widow of actor John Ritter, who died suddenly of an undetected aortic dissection.
Tim Russert's son, Luke, was interviewed this morning on NBC's "Today" show. He did his dad proud.
Luke had this to say about his relationship with his father.
(BEGIN VIDEO CLIP)
RUSSERT: There was always a lot of love from him. And we'd always hug. And, you know, he would say the same things he says to all you guys, you know, go get them, brother and put his hand across my shoulder. And there's not a day that goes by that I did not know my father loved me.
(END VIDEO CLIP)
KING: There's a major event going on in Detroit for Barack Obama tonight. And Al Gore will endorse him, the former vice president and presidential candidate.
There you see the scene now. And as soon as Al Gore speaks, we'll go right to it.
Dr. Newman, what did -- what did Tim Russert die of?
DR. MICHAEL NEWMAN, TIM RUSSERT'S PERSONAL PHYSICIAN: Tim had a cardiac arrest. It was related to a acute -- presumably acute dissection, rupturing plaque that's causing a blockage of a coronary artery. He had a heart attack -- a fatal arrhythmia.
KING: Did we know he had heart disease?
NEWMAN: Tim was known to have coronary artery disease and it was being treated with respect to management of his risk factors.
KING: Was he on medication?
Did he exercise?
Did he watch what he ate?
NEWMAN: Tim was on medication. I'd like to say -- I'm glad you mentioned exercise and watching what we eat. The foundation of management of heart disease and every medical condition, really, starts with lifestyle modification. You know, a healthy lifestyle and you'll have good health and you'll certainly have a healthy heart.
Tim -- Tim appreciated that. Yes, he exercised. He was on his Aerodyne bicycle.
KING: I'm going to cut into you, Dr. Newman.
We'll be right back with our medical panel.
Let's go to Detroit and Al Gore's announcement.
(INTERRUPTED FOR COVERAGE OF LIVE EVENT)
KING: Due to our political breaking news, Steve Carell will join us tomorrow. We taped Carell earlier today, a wonderful half hour. But the importance of this topic, heart disease, is too important to pass it by or limit it to a small amount of time. So we'll play that half hour of Steve Carell tomorrow.
You can lower your risk of a heart attack. We'll tell you how right after the break.
KING: We're back with our panel. In Washington, Dr. Michael Newman. In New York, Dr. Mehmet Oz. In Los Angeles, Dr. P.K. Shah. And also in L.A., Amy Yasbeck.
OK, from what Dr. Newman explained, Dr. Shah, could that have been prevented?
SHAH: It's difficult to say for sure. I mean most heart attacks and certain cardiac deaths can be prevented, but not all of them. And knowing the risk factors that put a patient at risk for sudden cardiac death or a heart attack is really the first step.
But in addition to knowing the risk factors, it is very important to really identify the most common disease that leads to this kind of a catastrophe.
KING: Dr. Oz, from what Dr. Newman said, could it have been prevented?
OZ: You can never tell for sure. And the reality is a big wakeup call. And it's the question that Tim Russert would be asking right now, is what are the odds that I could have done something different myself?
Let's examine it for a second. Of the 450,000 people a year who die of heart attacks in this country, probably half of them never knew they were at risk of a heart attack.
It's because the heart doesn't really have pain fibers. In fact, the only reason you ever feel any pain when you're having a heart attack is because the nerves in the heart cross other nerves -- from your chin, your arm or from the chest and the spinal column. And they short circuit each other out. And that creates this referred pain that in cardiology and cardiosurgery we recognize to be angina.
The other reality -- and this is a big wake up call for a lot of Americans, as well, is that a lot of the plaques that we have are not flow limiting. And by that I mean they don't cause a limitation on the amount of blood that courses through the veins that go to our heart.
Here's an example. This is the heart model. And...
KING: Hold on a second. I've got to get one more break in.
OZ: Yes, sir. OK.
KING: We'll come back with that. And then I want to Amy Yasbeck's -- what it's like to hear news of a sudden death.
A reminder, Steve Carell will be here tomorrow night.
Back from tonight's show, lessons to be learned from Tim Russert's death, when LARRY KING LIVE returns.
KING: A little while ago, Al Gore officially endorsed Barack Obama. No surprise. But it was a stirring introduction.
And here was Obama's reaction moments ago.
(BEGIN VIDEO CLIP)
OBAMA: Well, thank you Al Gore.
UNIDENTIFIED SUPPORTERS: Yes, we can! Yes, we can! Yes, we can! Yes, we can! Yes, we can! Yes, we can! Yes, we can! Yes, we can! Yes, we can! Yes, we can!
OBAMA: Thank you.
Thank you, everybody.
There are a couple of thank yous I have to make first of all.
OBAMA: I love you back.
OBAMA: I want to begin by thanking one of the finest governors in this country, somebody who is steering this ship of state through some rocky times. She does so with grace and intelligence and courage. I want everybody to give a huge round of applause to your wonderful governor, Jennifer Granholm.
OBAMA: To one of the finest Congressional delegations of any state in the nation, Carolyn Cheeks Kilpatrick, John Dingell, Sandy Levin, John Conyers, Bart Stupak, Dale Kildee...
(END VIDEO CLIP)
KING: That's Barack Obama moments ago thanking a lot of people after Al Gore's endorsement.
We'll be back with our panel, who will be with us the rest of the way.
Don't go away.
(BEGIN VIDEO CLIP)
OBAMA: I want to thank, most of all, Al Gore. I want to thank him for his support. I want to thank you for your service. I want to thank Al Gore for everything that he is doing to ensure that we leave a planet that is better for our children.
(END VIDEO CLIP)
KING: OK, now back to life and death. Amy Yasbeck, was your husband -- was John Ritter's death heart related?
YASBECK: It was vascular and cardio -- am I right, doctor? Cardio is heart and vascular is everything that comes from and to the heart. And the aorta is the part that comes from the heart to the rest of the body. Without your aorta, your heart's just doing a lot of work. It's not going anywhere.
KING: Like Tim Russert's wife, you got shocking news. Right?
YASBECK: Shocking, horrible news.
KING: And in his '50s as well.
YASBECK: Yes, John was 54.
KING: And Tim was 58. It's a double shock when it's not expected at all. Right?
YASBECK: Yes, because you don't really prepare. Maybe if you're growing old together and you talk about these things; we really never talked about anything like this, no.
KING: Before Dr. Oz shows us what he was going to show us earlier, Dr. Shah has brought along a defibrillator. Right? Dr. Newman, it was not used, is that correct?
NEWMAN: That's not correct.
KING: OK, it was used.
NEWMAN: NBC had a defibrillator. A resuscitation was begun almost immediately. NBC had an EAD on site and they were preparing to use it. At the same moment, the DC EMS, Emergency Medical Squad, arrived and they immediately defibrillated Tim. He had no heart rhythm. They defibrillated him. His heart was beating then in a ventricular -- fine ventricular fib, and then it deteriorated. They shocked him again. Actually, he was defibrillated three times before his arrival at Sibley Memorial Hospital.
KING: Before we get back to Dr. Oz and his demonstration, want to show us a defibrillator?
This is what's called an --
KING: Get a close up of this guy.
SHAH: -- AED, automatic External Defibrillator. It's basically an idiot-proof device that anyone can learn to use literally within five minutes. If used appropriately soon after cardiac arrest, it can bring a patient back to life by changing the electrical circuitry in the heart.
KING: Why do you think it didn't work in the Russert case?
SHAH: There are several possibilities. The longer the delay between the time collapse occurs and you begin defibrillation, the less the success of defibrillation. That's number one. Number two, if you're a very big sized individual and have a large heart, the larger the heart, the harder it is to get a successful defibrillation. The bigger the heart, the more likely you are to go back into fibrillation.
KING: Dr. Oz, what were you going to show us?
OZ: This is what the heart looks like. By the way, John Ritter tore this tube. This is the aorta that comes out of the heart, that brings the blood to the head, kidneys and everywhere else. When that tears, the blood from the heart spews out around the heart, rather than to the body. That's why most of the people with dissections will actually die.
Tim Russert died because this small vessel that brings life supplying blood to this miraculous muscle closed off suddenly. It's called the widow maker vessel. When this vessel closes off, the heart will often create a rhythm change, which is what causes sudden collapse that we often see. Unfortunately for a lot of Americans, we think that you can get a stress test, as was done with Mr. Russert, and that will show you have a blockage.
The reality is that often times the blockages are less than 50 percent. If that is the case, you exercise, the heart will go fast, but you won't see any abnormalities. But what happens a lot of times, and this is a reason you can't test yourself for safety, you have to live for safety, is that you get a thrombus, an irritation on top of a plaque that has been there for decades. But it when ruptures, that plaque all of a sudden comes alive. When you get a cut, whether it's inside the artery of the heart or on your skin, what do you do? You form a scab. That scab inside a very small diameter vessel closes suddenly. That's why Mr. Russert passed a stress test. That's why I actually think he was getting pretty great care. Yet, out of the blue, he's stripped from life.
KING: Would he have died, Dr. Oz, without pain?
OZ: I suspect he did not have much pain because as soon as you develop fibrillation, within seconds you pass out. From that perspective, it's the way I'd like to pass away, but I would rather do it when I'm 90 years of age. And that is the tragedy in America.
KING: More with our panel. If a stress test isn't an all clear, what other tests can tell us about heart health? You're watching LARRY KING LIVE.
(BEGIN VIDEO CLIP)
RUSSERT: We are surrogates for the American people. Very few places in the world have the kind of protections, particularly the Constitutional protections we have in this country as a free press. We have an obligation for all those men and women who work hard all week long in real jobs, that when they turn on CNN or turn on NBC or pick up a newspaper or turn on the radio, they realize someone else is working as hard as they are, trying to get to the truth. It's not an easy job, but you know what, Larry, it's the best one you can ever have. It's a vocation, being a journalist.
(END VIDEO CLIP)
KING: I couldn't put it better. Amy, by the way, is founder of the John Ritter Foundation for Aortic Health. The website is JohnRitterFoundation.org. Did he have much pain?
YASBECK: He had a band of pain that went around, and he had a lot of nausea. With aortic aneurysm and dissection there is -- right? Gastro-symptoms, because as your aorta expands, it pushes against your esophagus.
KING: He lived a while, didn't he?
KING: Dr. Newman, was Tim Russert a good patient?
NEWMAN: Tim was a great patient. Tim Russert as a patient was the Tim Russert that we all know. He complied with almost everything that was asked of him. He was well-informed, asked good questions. Tim was a good patient. Are there things all of us as patients could be better at? Sure. But Tim was a good patient.
KING: Do you ever think, Dr. Newman, in retrospect, I could have done more? Should have done more?
NEWMAN: You know, as physicians, we always hope that we can change people's lives, that we can make them feel better, live longer, that we can intervene, and that's what our role is. Unfortunately, in many instances, our hopes are not fulfilled. Absolutely, I wish Tim was alive and with us today. And I think most physicians, whether people -- patients die of heart disease or cancer, we all struggle with the fact there are limits to what we can do.
KING: Dr. Shah, if the stress test isn't a good indicator, what is?
SHAH: If you want to really identify disease in the arteries before even the arteries is narrowed or causes any symptoms or makes a stress test abnormal, you have to go with non-invasive imaging technology, which is currently available. A C.T. scan of the heart can look for calcification, or buildup of calcium, which is really tracking cholesterol buildup in the artery. That's one way to do it.
Another way is to do an ultrasound in the carotid arteries. And there you can identify plaque. If you have it in the carotid artery, you are very likely to have it elsewhere as well. You can detect these plaques long before they narrow the artery or cause any symptoms.
KING: What about what I took today, an echo-cardiogram?
SHAH: Echo-cardiogram is primarily used to check the function of the heart, the size of the heart and the valves of the heart. In your case, I know what your arteries look like, like on the palm of my hand, because we have examined them with CT and angiogram before, so we didn't need to do that for you.
KING: A lot of this, Dr. Oz -- I had a heart attack 20 years ago -- a lot of this is luck, isn't it? Where you have it, who's there?
OZ: For sure, those are issues that are important. Without question, we're dealt a hand that includes our genes. We have to play that hand accurately. If I can make one comment. We shouldn't confuse testing and detection with prevention. I think we're going to win the battle in America with heart disease not because we test better. I think my colleagues will agree. It's primarily about how we prevent these problems.
Here's an example; Tim Russert had through his arteries a corrosive fluid that was rusting away those tubes. We can give medications which will paint over the cracks in the wall of our health. Fundamentally, we need to change what the consistency of that fluid is.
Just to give you one action step right now for all the viewers, look at your waist size. If your waist size, measured at the level of the belly button, is more than half your height -- Let's do yours. How tall are you, Larry?
OZ: All right, 5'11. Five times 12 is 60, plus 11 is 71 inches, right, divided in half is 35 1/2 inches. If I were to measure your waist size with a tape --
OZ: That's wonderful. But, for most Americans, they use their belt size, big mistake, because guys will slip their belt under the fat. You actually have to measure with a measuring tape. If you violate that number, that law, if your waist size is more than half your height, you have too much belly fat. And it's that belly fat that causes the high blood pressure, the high cholesterol and the diabetes that we know is associated with heart disease.
KING: Let me get a break. We'll be back. A reminder, Steve Carell will be here tomorrow night. More of what you should know about preventing a heart attack after the break.
KING: Let's get a call for our panel. Langley, British Columbia, hello.
CALLER: Hello. My question is: is it correct that the younger you are when you get a heart attack, the less likely you are to survive against if you are over 70? Is that correct?
KING: Dr. Shah, that's a myth?
SHAH: Actually, that is not true. The younger you are, you have a higher chance of surviving. In fact, if you're over 70 and you have a heart attack, you have almost a six to ten-fold higher mortality than if you are a 50-year-old or less and have a heart attack. It's just the opposite.
KING: Dr. Newman, did he have diabetes?
NEWMAN: No. Tim did not have diabetes. Tim did have a minimally elevated glucose. It was -- at his last test, it was 104 and his hemoglobin A1C, which is another indicator of one's sugar, was 5.7, which is well within normal. He did not have diabetes.
He was overweight. His cholesterol was appropriate. Cholesterol wasn't Tim's issue, with respect to LDL cholesterol. He had elevated triglycerides at one point and a low HDL. However, most recently, his LDL cholesterol was 68. He had a low HDL. Originally, his HDL was in the 20s and we were able to get it up to 37.
So Tim had an acceptable lipid profile considering where we started from. I'd like to come back to the point about prevention, because prevention doesn't begin with a cardiologist. Prevention begins with the internist, with the family practitioner, even with the pediatrician, with the gynecologist.
By the time Dr. Shah and Dr. Oz are seeing patients, prevention has failed. They're dealing with secondary prevention. It's practitioners like ourselves that are dealing with primary prevention. And we have the opportunity to really make quite a difference. There was a recent study published in the New England Journal based on a study done by the Center for Disease Control. From 1980 to 2000, deaths from heart disease decreased by nearly 50 percent. That was quite significant. They looked at that improvement or the reduced death rate and what was it attributed to? Forty seven percent was due to interventions, bypass surgery and those types of interventions. Whereas risk factor modification, diet, weight reduction, exercise, blood pressure, cholesterol, glucose, and tobacco, these are the factors that really make a difference. These are the things that internists have an opportunity to deal with.
KING: I have to get -- Amy, you want to say something?
YASBECK: It's true about prevention and that. Another thing that's before that even is the genetic factor. What we're learning now -- what we're learning now is the thing that John died from, familial aortic dissection, there's other causes of aortic dissection that if somebody in the family has it, all the first degree relatives get scanned, the kind you're talking about, but also genetic testing. If you know your kids have a higher rate of developing this, you're going to be on that with the prevention.
KING: Good point.
KING: We'll wrap it up when LARRY KING LIVE returns.
(BEGIN VIDEO CLIP)
REGIS PHILBIN, "LIVE WITH REGIS AND KELLY": I'm laying in bed and I'm thinking, 6:30 in the morning, I've got to be over to New York Presbyterian Hospital to get this thing done. Can't sleep, tune on Letterman. He says, well, it will happen tomorrow morning. Regis Philbin is going to be checked into the hospital. They're going to put him on a gurney and bust him open like a lobster!
DANA CARVEY, COMEDIAN: Was running, running, had a little burning in that chest area. Had the burning, went in, had a test, said we think something funky is going on.
(END VIDEO CLIP)
KING: As always, visit CNN.com/LarryKing for ring tones, quick votes and podcasts. This week, it's Kathy Griffin. Tomorrow night, Steve Carell. Friday night, an exclusive with Motley Crew. Still time to send them an e-mail or an I ask question.
Dr. Oz, good question from our control room; could the fact have been that he flew home all night from Rome, went to work early in the morning with little sleep?
OZ: Stress is an important role. And we know the response to stress drives a lot of heart disease. I don't think that was it. I think he had a predisposition to inflammation. He had the arteries that weren't normal to begin with. If I can address one more time this issue of genes versus lifestyle. The fact of the matter is that we control 70 percent of how we age. Tim did, too. Although, he could have lived five years longer or five years shorter, the bigger changes are ones we can drive.
Number one driver of aging of all, that we haven't touched on yet, is blood pressure. The average blood pressure is not good enough for you. Guess what happens to the average American, they die of a heart attack. You want to have the optimal blood pressure. Remember this number, 115 over 75. You can check your blood pressure anywhere. They have little wrist devices to do it. You can get it at any mall. Simple to do. Check it a couple times a week, easy number.
KING: P.K., you agree with that?
SHAH: I agree blood pressure is an important risk factor. I also agree that genetics loads the gun, but lifestyle really pulls the trigger. You can modify what you inherit.
KING: One more quick call. Linda, New Jersey, hello.
CALLER: My name is --
KING: I don't need your name. What's the question.
CALLER: OK, I'd like to know if I just started -- I'm 41 years old. I just began to take blood work done. My doctor ordered it. I have no history of heart problems in the family. I'm wondering at what age, if any, and how often should I take this overall blood work with the HDL level?
KING: When do you start all that?
SHAH: If you have no family history and no other bad habits, I think certainly in your 20s and 30s, you should definitely get the first blood panel done. As Dr. Newman mentioned, by the time you are 50 or 55, the disease is already far a advanced.
KING: I did blood panel today. They took about ten capsules of blood.
SHAH: Correct, of course.
KING: Yes, I'm OK. He says I'm OK.
SHAH: He's in good shape.
KING: They took a lot of blood, though. I thought I would collapse from too much blood loss.
SHAH: Actually, going back to the blood tests, it should be done at a younger age and periodically thereafter because that's the time that you intervene. You have the best chance of preventing this catastrophe. KING: Dr. Shah is on the medical advisory board of the Larry King Cardiac Foundation. And Amy Yasbeck has the John Ritter Foundation for Aortic Health. That websites is JohnRitterFoundation.org. And our foundation is LKCF.org. That's all part of this concept.
Dr. Michael Newman, Dr. Mehmet Oz, and Dr. P.K. Shaw and Amy Yasbeck have been our special guests tonight. And Steve will be our guest tomorrow night. And I thought I had a read here, but apparently I don't. There it is.
They told me -- "Meet the Press" went on yesterday without its usual moderator, a difficult assignment for Tom Brokaw. Take a look.
(BEGIN VIDEO CLIP)
TOM BROKAW, NBC NEWS ANCHOR: "Our issues this Sunday," Tim Russert started every edition of "Meet the Press" with those four words, and those were the words that he was preparing to record when he collapsed and died on Friday at these NBC studios in Washington. Now his moderator's chair is empty. His voice has been stilled and our issue this sad Sunday morning is remembering and honoring our colleague and our friend with some of the men and women who worked with him and appeared here on "Meet the Press," who knew him best and loved him most.
(END VIDEO CLIP)
KING: I knew Tim Russert pretty well. He appeared on this program quite often. And it's hard to deny that his loss is incredible. It's still hard to believe that there's no Tim Russert and how much he will miss this political campaign ahead. We thank our guests. Steve Carell tomorrow night. And now here's Campbell Brown with "AC 360." Campbell?