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- NEW: Head of a Rome hospital's emergency department blames heart attack for death
- James Gandolfini was dead when he arrived by ambulance at a Rome hospital
- The U.S. Embassy in Rome will issue a death certificate
- Medical examiners must conduct an autopsy within 24 hours after the body's arrival in the morgue
Rome (CNN) -- James Gandolfini probably died of a heart attack, according to the head of a Rome hospital's emergency department where the actor was taken.
The body of the actor was transferred to a hospital morgue in Rome early Thursday, where it awaited an autopsy.
By law, medical examiners in Italy are required to carry out the postmortem 24 hours after the body's arrival in the morgue, a hospital spokesman said.
Before Italian authorities can release his remains for transport back to the United States, the U.S. Embassy in Rome must issue a death certificate.
Gandolfini was not alive when he arrived by ambulance at the Policlinico hospital late Wednesday, spokesman Antonio Spasola said.
No one from the embassy or Gandolfini's family has contacted the morgue yet, he said.
Enjoying Italy
Hours before he died, Gandolfini told Mario Sesti by phone how much he was looking forward to the next leg of his Italian vacation.
He was heading for Taormina in Sicily, a quaint town packed with historical architecture and nestled between lush green hills and the azure waters of the Mediterranean Sea.
There, he was to receive an award at a local film festival held before the backdrop of an ancient Roman arena.
Sesti, who heads the festival, was eagerly awaiting Gandofini's arrival Friday. He was shaken by the news of his death.
Sesti will replace the award ceremony with a tribute to Gandofini's lifetime achievement.
"He was the American actor who better than anyone else was able to interpret the Italian-American society, with all of its rich contrasts, ambitions, pain, humor," Sesti said.
Possible health risks
Though the cause of death is not yet known, his managers believe that a heart attack killed the man who portrayed Tony Soprano, a washed-up mob boss prone to keeling over from panic attacks.
He was 51.
"This is young to have a heart attack, even when you look at any pre-existing health conditions," CNN chief medical correspondent Sanjay Gupta said. Usually, first heart attacks don't strike until the victim is older than 60.
But risk factors such as obesity, smoking, lack of exercise and stress can cause them to occur earlier in life, Gupta said.
"He loved his food. He didn't push back from the table," said journalist Larry King, who spent time with the actor on and off camera.
Photos and anecdotes indicate that Gandolfini enjoyed cigars.
Though intense outbursts of adrenaline-infused anger were a mainstay of Tony Soprano's character, he was a far cry from Gandolfini.
Jovial, fun, reserved
Colleagues described him as funny, kind and gentle. He had a reputation for often being reserved and quiet. He didn't seek publicity, avoiding media coverage, journalists have said.
Tributes poured in on social media, describing Gandolfini as jovial and likable.
Actor Mark Ruffalo shared his grief on Twitter: "Oh Jimmy. It's a crying shame. You stormed in and out. Your voice like velvet granite. From a whisper to a shout. A comet of a man."
Even after his "Sopranos" fame, he was very down to earth, said iReporter Pat Tantalo, who worked on the set of a 2006 movie Gandolfini starred in.
He lit up the room with a big smile the first time he walked into the production office, Tantalo recalled.
"We instantly connected. He planted his huge mitts on my shoulders and called me a little bull."
Tantalo posted a goodbye tribute on CNN's iReport website with a photo of Gandolfini's arm around his shoulder. Both men are smiling ear to ear.
They exchanged telephone numbers and spent some of their evenings sitting around together on a deck by a lake smoking cigars and telling stories.
"It was like we had been friends forever," Tantalo said.
IReporter Shana O'Neil met Gandolfini when he was shooting in her office in 1994. She remembers him as "Jersey through and through," a trait he did share with mobster Tony Soprano.
But he was so much friendlier, O'Neil said. "I just always think of him as that guy."
His "Sopranos" fame, she said, changed nothing about the way she remembers him.
CNN's Hada Messia and Livia Borghese contributed to this report.
