James Gandolfini was staying at the luxurious Hotel Exedra in Rome when he was stricken.
He was in an elegant suite with his 13-year-old son, Michael. At 10 p.m. Michael called the front desk telling them his father had collapsed inside the bathroom. Paramedics arrived within minutes and found Gandolfini alive but in cardiac arrest.
ABC correspondent Lama Hasan reports from Rome. "You can only imagine what a 13-year-old boy watching his father suffer, knowing that he is sick, really just going to the phone and trying to get help, then finding out that he's pronounced dead."
Gandolfini was rushed by ambulance to the Policlinico Umberto Hospital three miles away, but it was too late. The famed actor was pronounced dead at 10:40 p.m.
A family friend broke the news in Rome. Michael Kobold told the media, "First aid was administered before Mr. Gandolfini was taken to the hospital. He died of an apparent heart attack."
Now, people are asking if there were signs something was seriously wrong.
ABC's Chief Medical Editor Dr. Richard Besser told INSIDE EDITION, "What I would want to ask is, does he have risk factors? Was he a smoker? Did he have high blood pressure or high cholesterol? Did someone in his family die of heart disease at a young age?"
A photo of Gandolfini on March 27th in New York showed him looking winded and needed to hold on to the pole for support as he caught his breath.
One month later, on April 27, Gandolfini appeared in Los Angeles for a police fundraiser. He played poker for charity and looked uncomfortable and sweaty.
Dr. Besser told us that 51 is a very young to have a heart attack.
"I hope that this is a wake-up call for people. You can be going about your activities, out with your children enjoying your day, and that night have a heart attack. You have to look at the risk factors and take them seriously," said Dr. Besser.
Gandolfini's first wife, Marcy flew to Rome to be with her son.
Gandolfini was vacationing in Rome to show his son their Italian heritage. He was scheduled to be honored at a film festival in Sicily. Instead, they will now celebrate his life with a tribute Saturday night.
INSIDE EDITION's Paul Boyd asked Hasan, "What are you hearing about the timeline? What happens next?"
"An autopsy, which will most likely determine the cause of death, is probably going to take place Friday morning," replied Hasan.
Back home at his Greenwich Village apartment in New York City, his neighbors are devastated.
One neighbor told INSIDE EDITION, "There wasn't anything he wouldn't do for somebody. He was kind to people in the apartment building, and a wonderful dad."
Gandolfini recently became a father for the second time. His daughter Liliana is just 8 months old. Gandolfini's wife of a year, Deborah Lin, was not with him in Rome.
Ironically, Gandolfini's death was foretold in a scene from a 2002 episode of The Sopranos in a heated exchange between Gandolfini's character Tony Soprano and Michael Imperioli's character Christopher Moltisanti.
Tony: "We're here to talk about you killing yourself with drugs."
Christopher: "I'm going to kill myself? You're going to have a heart attack by the time you're 50."
Now, sadly, it's happened in real life.