One of the features of heart disease is, indeed, the suddenness with which it takes its victims. With other diseases there are usually the warning symptoms and then a diagnosis and a warning that death may occur within a certain time frame if treatment is not an option. The patient's condition may visibly worsen and then friends and family gather to say goodbye. There are a few known causes of very sudden death aside from accidents, and these are usually cardiovascular. Stroke, aneurysm, AVM, pulmonary embolism--these too will strike suddenly and sometimes without prior warning. One may get a warning that one is vulnerable to stroke or heart attack, or has an AVM, but the timing of the final event is unknown. Walking around with this knowledge is a lot like living under the fabled sword of Damascus.
Usually when you hear someone has died of a "massive heart attack" what they are really talking about is sudden cardiac arrest. Newsweek has an article explaining how heart disease leads to heart attacks and, potentially, sudden cardiac arrest. I think it is important to remember that risk factors, such as having plaque in your coronary arteries, are like lottery tickets. One can "win" with only one ticket, but the more tickets you have the greater your chances of "winning." In the case of having lots of risk factors, or tickets, for sudden cardiac arrest, winning can mean a quick death unless a defibrillator is immediately available and implemented. But, remember, it only takes one ticket to win, and any plaque in the coronary arteries creates the danger of a rupture and subsequent blood clot.
Dick Cheney has so many lottery tickets for a cardiac event based on his previous heart history that he was implanted with a defibrillator internally that is supposed to kick in and restart his heart if it should falter. Given that stress is a huge risk factor and that being a Vice President is stressful, one can imagine that an implanted defibrillator is a must-have accessory for a politician with heart disease.
No matter how long a person has heart disease prior to their death, it still comes as a shock. I remember getting the call that my mother had died and not quite believing that it had finally come. She'd had two coronary artery bypass surgeries and had lived with heart disease for twelve years and still I was not prepared for that call. It's all the more shocking if your loved one has not been diagnosed--many people do not survive their very first heart attack--or has been living very successfully and managing all their risk factors to the best of their ability.
Likewise I was shocked by the sudden death of my father, which resembled Tim Russert's death. My dad didn't even know he had heart disease on the day he died while working in his garden. He had passed a physical just six months earlier.
Living with heart disease means that you have to be sure to let the people in your life know every day that they are loved. You may not get a chance for the dramatic death bed scene where you get to say your farewells. Isn't that something we all should do, regardless of risk factors? After all, accidents also take people suddenly and without prior warning.
My heart goes out to Tim Russert's family, including his second family at NBC.