If you smoke, stop now. Gandolfini smoked.

“Smoking increases the risk of sudden death and other cardiovascular deaths. The good side is cessation of smoking reduces the risk… within weeks … that positive action shifts the odds in your favor,” Myerburg said.

“Sudden cardiac arrest is something that is quite preventable,” Splaver added. “This is something we can screen for. If we can identify who has a weak heart by doing a simple test like an EKG we can identify patients at risk. Patients with dizziness, lightheadedness, blacking-out, fainting, should be evaluated.”

Sleep apnea can also lead to rhythm disturbances of the heart muscle. Those who are overweight are at greatest risk for sleep apnea — an interruption of the breathing while sleeping — although even fit, thin people can suffer from sleep apnea.

Gale remembers few details of that evening in September 2010 that changed his life.

“I was sitting at a high-top table. There was wine in front of me and my girlfriend on the other side of me. The rest is what they told me happened,” he said Friday. “My chin dropped to my chest and I was out. The woman sitting close by noticed — she was a nurse and she gave me CPR until the EMTs came.”

Gale was rushed to Westside Regional Medical Center in Plantation. The determination: silent ischemia, a lack of blood flow and oxygen to the heart due to a blocked artery.

“I had not a sign, not a pain, not a symptom and that is called silent ischemia. You don’t want that. Pain is good. You want to know so you can take proactive measures,” Gale said.

He eventually found his way to the University of Miami Hospital where he has been under the care of Myerburg. He has since undergone the placement of stents to open blood flow, underwent triple bypass surgery and had an implanted defibrillator. In his case, electrocardiogram (EKG) tests of his heart couldn’t determine why he kept having problems because the electrical system of the organ wasn’t compromised. Rather, an inherited tendency to build up artery clogging cholesterol led to a diagnosis of hypercholesterolemia. This syndrome can be detected when a patient undergoes stress testing, thus pointing out the importance of having your doctor perform that test, especially if a first-degree family member, like a parent, grandparent or sibling, suffered from early cardiac arrest. Gale’s father and grandfather died in their 40s and 50s from cardiac arrest. High cholesterol runs in his family.

The greatest challenge in cardiology is identifying patients who might be at risk, Myerburg said. The University of Miami Hospital has established a monthly clinic to focus on hypertrophic cardiomyopathy and other inherited and acquired causes of heart rhythm disturbances through screenings, physical evaluations, family histories and genetic testing.

Of Gale’s initial attack: “He had cardiac arrest and there was someone around to give CPR,’ Myerburg said. “He’s the parallel of Gandolfini and, in other ways, he’s the antithesis. It was probably the same kind of event, but on the other hand, he had somebody around to give CPR and that got him resuscitated. And he’s a recreational athlete and he’s got his whole life back. He’s the counter of that story.”

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