Bob Odenkirk’s Heart Attack

Actor Bob Odenkirk — best known for his role as Saul Goodman on “Better Call Saul” — collapsed on an Albuquerque set while shooting the sixth and final season of the “Breaking Bad” spinoff. Odenkirk was taken to a local hospital for a “heart-related incident.”

Later that same week, Odenkirk took to Twitter to reassure fans: “Hi. It’s Bob. Thank you. To my family and friends who have surrounded me this week. And for the outpouring of love from everyone who expressed concern and care for me. It’s overwhelming. But I feel the love and it means so much.”

“I had a small heart attack,” he added. “But I’m going to be OK thanks to Rosa Estrada and the doctors who knew how to fix the blockage without surgery…. I’m going to take a beat to recover but I’ll be back soon.”

Heart attacks, or myocardial infarctions, most often occur as a result of ischemic heart disease, also called coronary heart disease or coronary artery disease (CAD), which is due to the buildup of plaque in the arteries. Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. Over time, plaque hardens and narrows the arteries, restricting blood flow.

A less common cause of heart attack is a severe spasm of a coronary artery cutting off blood flow through the artery. Spasms can occur in coronary arteries that aren’t affected by atherosclerosis.

What causes a coronary artery to spasm isn’t always clear. A spasm may be related to:

• Taking certain drugs, such as cocaine
• Emotional stress or pain
• Exposure to extreme cold
• Cigarette smoking

Heart Disease in the U.S.

Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the U.S.; about 655,000 Americans die from heart disease each year, according to the CDC. About 18.2 million adults ages 20 and older have CAD, and about two in 10 deaths from CAD occur in adults younger than 65.

In 2014 to 2015, heart disease cost the U.S. about $219 billion each year. This included the cost of healthcare services, medications, and lost productivity due to death.

Risk Factors

High blood pressure, high cholesterol levels, and smoking are key risk factors for heart disease. About half of Americans (47%) have at least one of these three risk factors. Several other medical conditions and lifestyle choices can also put people at a higher risk for developing heart disease, including:

• Diabetes
• Overweight and obesity
• Unhealthy diet
• Physical inactivity
• Excessive alcohol use

Treatment for Heart Attack

Early treatment for a heart attack can prevent or limit damage to the heart muscle. Rapid activation of the 911 emergency system at the onset of symptoms can be lifesaving.

In suspected heart attacks, there are interventions that can begin prior to arrival at a hospital. These include:

• Aspirin to prevent further blood clotting
• Sublingual nitroglycerin to act as a vasodilator, reducing the heart’s workload and improving blood flow through the coronary arteries
• Oxygen therapy

Treatment for Chest Pain

Once the diagnosis of a heart attack is confirmed or strongly suspected, treatment to restore blood flow through the blood vessels supplying the heart is undertaken. The two main treatments are thrombolytic agents and percutaneous coronary intervention (also known as coronary angioplasty), a procedure used to open blocked coronary arteries.

Thrombolytic agents

The first thrombolytic agent was discovered in 1933, when William Tillett, MD, serendipitously observed that streptococci agglutinated plasma, but not serum. Later, the active agent, streptokinase, was isolated. In 1958, streptokinase was first successfully used in patients with acute myocardial infarction.

Subsequently, a protein called tissue plasminogen activator (TPA), a serine protease found on the endothelial cells that line blood vessels, was detected. It acts as an enzyme and catalyzes the conversion of plasminogen to plasmin — the major enzyme responsible for clot breakdown. Studies have found that an accelerated regimen of TPA (administration over a period of 90 minutes, with two-thirds of the dose given in the first 30 minutes, instead of the conventional period of 3 hours) resulted in significant reductions in death and disabling strokes among patients with acute myocardial infarction.

A number of other thrombolytic agents have been developed, many through the use of recombinant biotechnology, including alteplase, reteplase, and tenecteplase.

Percutaneous Coronary Intervention (PCI)

PCI is a nonsurgical procedure that improves blood flow to the heart. A catheter with a balloon or other device on the end is threaded through a blood vessel, usually in the groin, to the narrowed or blocked coronary artery. Once in place, the balloon located at the tip of the catheter is inflated to compress the plaque and related clot against the wall of the artery. This restores blood flow through the artery. During the procedure, the doctor may put a stent in the artery. The stent helps to keep the blood vessel open to prevent blockages in the artery in the months or years after the procedure.

PCI is generally safe but there are a few possible complications. Risks include:

• Allergic reaction to the drug used in a drug-eluting stent, the stent material (very rare), or the x-ray dye
• Bleeding or clotting in the area where the catheter was inserted
• Blood clot
• Clogging of the inside of the stent (in-stent restenosis), which can be life-threatening
• Damage to a heart valve or blood vessel
• Heart attack
• Kidney failure (higher risk in those who already have kidney problems)
• Arrhythmias
• Stroke (this is rare)

Cases of advanced coronary heart disease may require a surgical procedure, such as coronary artery bypass grafting (CABG). CABG uses blood vessels from another part of the body and connects them to blood vessels above and below the narrowed artery, bypassing the narrowed or blocked coronary arteries.

Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children’s Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.