Worldandnation: Turns out, there's twist to Bush fainting episode

Turns out, there's twist to Bush fainting episode

The president's superb health probably made him susceptible to a common reflexive action after choking on a pretzel, doctors say.

By WES ALLISON, Times Staff Writer

In the old days, it was called swooning.

When it happens to the president of the United States, it's called vasovagal syncope.

News reports that President Bush passed out Sunday evening after choking on a pretzel left some questions unanswered.

Passed out?

From a pretzel?

What apparently happened, experts and the White House say, was vasovagal syncope, a reflexive action that depresses the heart rate and causes a brief faint.

Bush said Monday he was watching the Baltimore Ravens wallop the Miami Dolphins when a hard pretzel "went down wrong" and triggered a coughing fit, followed by the blackout. He rolled off the couch and hit the floor. The spill left a raspberry the size of a silver-dollar on side of his face. He thinks he was out for several seconds.

"I hit the deck. Woke up and there was Barney and Spot (the family dogs) showing a lot of concern," Bush told reporters Monday before leaving for a two-day trip to the Midwest to sell his economic package. "I feel fine."

Independent physicians said they can't say for sure what happened without examining the president. But they said the official explanation of vasovagal syncope seems likely.

"The scenario sounds right," said Dr. Stephen Glasser, a Tampa cardiologist. "It is very common."

The vagus nerve, which sends commands to the heart and the intestinal tract, serves the mellow half of the nervous system: When the blood pressure or heart rate shoots up, the nerve sends signals urging them to calm down.

Normally the system works just fine. But sometimes, when people are struck by fear, or sudden cold, or a sighting of the Backstreet Boys, or some other emotional or physical trigger, the nerve is stimulated at an inopportune time. That can cause a blackout.

Emergency room physicians say vasovagal syncope is among the most common reasons for loss of consciousness. It can be scary, but it is generally harmless.

Glasser noted it frequently occurs when people have blood drawn. "The puncture doesn't cause the vagus nerve to be activated, but the mental triggers (surrounding) that," he said.

Dr. Joel Strom, director of cardiology at the University of South Florida in Tampa, suggested this likely chain of events:

The president inadvertently inhales a piece of pretzel, irritating the larynx or trachea and causing the upper respiratory tract to spasm. He coughs, and perhaps has trouble breathing. As he tries to exhale against the chunk of pretzel lodged in his throat, his blood pressure jumps.

To compensate, the vagus nerve orders the heart to slow and blood vessels to dilate.

"You'd get a drop in blood pressure, and guess what? You pass out," Strom said. "As soon as he passed out, everything relaxed and he comes back."

Inhaling even a tiny piece of food or other irritant can trigger an episode. Peanuts are often the culprit, Strom said.

The president runs almost every day. He boasts lower-than-average blood pressure and a low resting heart rate, which actually made him more likely to suffer a blackout. That's because low blood pressure doesn't have as far to fall before it becomes too low.

"Younger and more athletic people tend to have higher vagal tone, and do react from vegal (stimulus) more significantly than others," Glasser said.

Bush, 55, was examined by the White House physician shortly after the spell and was pronounced in excellent health, though he is suffering from a head cold. He later dined with his wife, Laura. During Monday's flight from Washington to the Midwest, Bush made light of the spell by sending a large bag of pretzels to reporters on Air Force One with a scribbled warning to "chew slowly."

"My mother always said, "When you're eating pretzels, chew before you swallow,' " Bush said. "Always listen to your mother."