diabetes mellitus and coronary artery disease led to sudden cardiac death. The immediate cause of death was an occlusive coronary thrombus ......... in the left anterior descending artery, and a fresh blood clot was visible on one of these plaques.
Left Anterior Descending has another, very descriptive name - Widowmaker.
Diabetics are at an increased for developing sclerotic lesions, and often get very vague anginal pains or none at all, so they may get no warning. My guess is that the lesion in his LAD artery was moderate and did not close off the circulation to a degree which would produce typical findings on the stress test.
Typically, this is exactly what happens - a sclerotic plague will break, and when platelets get exposed to the break and to the contents of the plague, they become activated and stick to each other to form a clot. They normally respond this way to any break in any vessel, and this way they stop the bleeding. Unfortunately, when this happens in a coronary artery, a partial blockage becomes total, and the person develops a heart attack.
Usually there is a time period during which the heart attack can be aborted - through the use of clot busting medications (thrombolytics), or a percutaneous intervention and stenting. But when this event occurs in a major vessel - Left Main - or the LAD, especially in its beginning (proximal) portion, large parts of the heart muscle lose blood supply all at once, and the result may be sudden death. That's what happened to poor Mr. Russert. |
