Lessons from James Gandolfini

  James Gandolfini's death hit hard here in New Jersey. He was a larger-than-life figure in this state, and that, in a literal sense, may have had something to do with his sudden death at the age of 51.
   The Star-Ledger, the newspaper "Tony Soprano" retrieved off his driveway every morning, interviewed Cardiologist  Barry Cohen of Morristown Medical Center on June 21st about identifying and potentially avoiding fatal heart attacks, which (pending an autopsy) is believed to have killed Mr. Gandolfini.
     Dr. Cohen is Medical Director of the cardiac catheterization lab at Morristown, and author of the book "Coronary Heart Disease: A Guide to Diagnosis and Treatment."
      Dr. Cohen described a fatal heart attack as a situation where the arteries feeding the heart muscle - he used the helpful analogy of a gas line to your engine - become clogged. There is instability in the electrical impulses to the heart, and the heart goes into a chaotic rhythm.
       Symptoms of a fatal heart attack are familiar to many: shortness of breath, chest pain, arm pain, throat  pain and sweating. However, approximately one-third of  heart attacks occur without any warning.
      While Mr. Gandolfini was overweight, that in itself is considered an independent risk factor. There are others, including elevated cholesterol, high blood pressure, and diabetes, all of which can be weight-related; and smoking. The most important factor is family history. I have read many times that family history is 50%, and all other factors can add up to the other half. So no matter what shape you are in, you can't out-run your genes.
    As far as triggers to an actual heart attack, everyone is familiar with these: stress, anger, and, again, smoking.
    As far as prevention, Dr. Cohen's suggestions are solid and sound: a diet low in saturated fats, with lots of fruits and vegetables, and exercise. If you are smoking, quit now! See a doctor regularly for check-ups, and monitor your blood pressure. Don't just shake it off if you feel any of the symptoms of a heart attack mentioned above. It may be the warning sign to get medical help before a fatal heart attack occurs.
   Larger than life in a mythic sense is one thing - in a literal sense, it's quite different.