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Something must trigger it , " Dr. Maria Araneta told attorneys on both sides of the lawsuit , according to a transcript of the deposition obtained by The Associated Press.She said Robert Ernst , whose widow , Carol , is the plaintiff in the case , probably had a heart attack because a blood clot blocked blood flow in an artery already clogged with plaque . The South Texas case is the first to go to trial among more than 4,200 state and federal lawsuits.The trial , which began July 14 , has drawn national attention from pharmaceutical companies , lawyers , consumers and stock analysts as the first test of what lies ahead for the drug maker . But the company has relied heavily on the autopsy report in the Ernst case , saying no studies link Vioxx to arrhythmia so the drug could n't have caused Robert Ernst 's death.The coroner who wrote the report testified last week that Ernst more than likely died of a heart attack , but his death was too sudden for his heart to show damage.As his widow testified , at least two jurors appeared to wipe tears from their eyes when she described her life since her husband died just one month shy of their first wedding anniversary . That claim garnered a rebuke from the U.S. Food and Drug Administration for making that assertion without scientific proof.After two years of wrangling with the FDA , Merck added warnings about cardiovascular risks to Vioxx 's label in 2002 . She said that was consistent with Merck 's belief that the older painkiller decreased blood clots _ which can cause heart attacks _ and that Vioxx lacked that effect on patients.Santanello also testified that before Vioxx went on the market , Merck tested it in 54 clinical trials involving 10,000 patients , comparing its effects to those of other anti-inflammatory drugs and sugar pills.Those trials _ which Lanier alleges were designed to produce statistically insignificant results _ showed no differences in adverse affects to users of Vioxx and the other pills , Santanello said.Merck in 2002 added warnings about cardiovascular risks to Vioxx 's label after two years of wrangling with the FDA . Sponsored by The William Penn Foundation , this was no ordinary gathering at which people who represent various and , perhaps , antagonistic perspectives . At the time , Merck attributed the difference to naproxen 's heart-friendly qualities rather than a defect in Vioxx , garnering a rebuke from the Food and Drug Administration for making that assertion without scientific proof.After two years of wrangling with the FDA , in 2002 Merck added warnings about cardiovascular risks to Vioxx 's label .