My take: Tim Russert

WSJ Health Blog: “Russert’s doctor Michael Newman said the tough-questioning but congenial host of NBC’s ‘Meet the Press’ had been under treatment for asymptomatic coronary disease, but that it was under control with medication. He was carrying excess weight, Newman observed, but he got regular exercise and he performed well on an exercise stress test in April.”

GruntDoc: “I therefore propose a new sign in medicine, the Tim Russert sign: death (or MI) shortly after a negative stress test.”

I don’t have all the medical information, so I’m speculating.

From what I heard last night, Mr. Russert was urged to lose weight and had previously diagnosed coronary artery disease. It would not be unreasonable to assume that he was already on a statin, aspirin, and blood pressure medication (as his enlarged heart can be caused by chronic hypertension).

A point of debate is his negative stress test 2 months ago. It is unclear what type it was – an exercise stress test, stress echocardiogram, or nuclear stress test? This matters, as the sensitivity would vary from 80 to 90 percent.

The gold standard to determine the extent of coronary artery disease is a cardiac catheterization. However, this is not typically done in an asymptomatic patient with a normal stress test. No doubt there will be calls to do so in light of Russert’s death.

Did he have any symptoms prior to the MI? Colleagues said he did not “feel well” in the days prior to the event. Was this his anginal equivalent?

Finally, it is likely he collapsed from ventricular fibrillation, which is a shockable rhythm. Did the Washington bureau have an AED? Was it used? Even so, Mr. Russert’s chances of survival would still have been slim.

A sad day indeed and a tragic loss in the world of journalism and politics.

Further reading has revealed that Russert had diabetes, and the autopsy revealed significant left anterior descending coronary artery (LAD) atherosclerosis (the so-called “widow maker”).

He passed his exercise stress test “at a high level of exercise.” Hypertension and cholesterol were reported to be well-controlled.

Still can’t find whether the stress test was with imaging or not. It makes a difference in the detection of Russert’s plaque:

Imaging tests are more sensitive than the exercise ECG in the detection of severe (three vessel and left main) disease . . . the sensitivity for severe disease was 93 to 98 percent with planar thallium imaging, stress echocardiography, and SPECT perfusion imaging compared with 86 percent for exercise ECG testing.

Given his risk factors, I would not be surprised if Russert’s PCP will take heat (or even be vulnerable to a malpractice lawsuit) if the stress test was ordered without some kind of imaging.