Doctors tiptoe around calling it a heart attack
By BILL ADAIR and MARY JACOBY
© St. Petersburg Times, published November 23, 2000
WASHINGTON -- Vice presidential candidate Dick Cheney had a heart attack Wednesday morning, but for several hours, his doctors gave a misleading account that suggested he was a healthy man.
Dr. Alan Wasserman, a George Washington University cardiologist, said Cheney, 59, had "chest discomfort" when he was taken to the university's hospital. He said doctors discovered "some additional narrowing" of an artery, but he portrayed Cheney as remarkably healthy.
Late Wednesday afternoon, Wasserman and other cardiologists told the rest of the story:
One of Cheney's arteries was 90 percent to 95 percent blocked and had to be opened with a device called a stent. Cheney, who had quadruple cardiac bypass surgery in 1988, had actually suffered his fourth heart attack in 22 years.
Wednesday night in a telephone interview from his hospital bed with CNN's Larry King, Cheney said, "Everything's fine." He said he hoped to be discharged from the hospital in "a day or two."
"He was never at risk of dying from this," said Dr. Jonathan Reiner, a cardiologist who treated Cheney. He and other doctors characterized it as a slight heart attack and said it was so minor that it would not be considered one until standards were changed a year ago.
But Wednesday's confusing episode raised new questions about the former defense secretary's health at a time of great uncertainty about the election results.
Cheney's health has been questioned many times during his career in Washington, but the Bush-Cheney campaign has repeatedly refused to release medical records.
A campaign spokeswoman said Wednesday night that instead of actual records, they had provided a letter of support from a prominent heart surgeon that said Cheney was fit to be vice president.
"There has been no vice presidential nominee who had ever put forth that information," said Juleanna Glover Weiss, Cheney's spokeswoman. "By having one of the top doctors in the country come forward, we made an extraordinary effort to alleviate any concerns."
Doctors at George Washington University Hospital predicted a hospital stay of a few days and a recovery of a few weeks for Cheney, whose history of heart disease dates to his late 30s. His first heart attack, at age 37, was in 1978. He had a second in 1984 and a third in 1988. All were described as mild. In August of 1988, Cheney underwent bypass surgery because of arterial blockages.
About 3 a.m. Wednesday, Cheney felt chest pains while lying in bed. He quickly went to the emergency room of the university hospital. Doctors performed blood tests to see if his blood enzyme levels were elevated. A high level indicates that a patient has had a heart attack, which is muscle damage to the heart caused by an inadequate blood supply.
The initial test, about 8 a.m., showed enzyme levels were normal. An electrocardiogram, a measurement of the heart's contractions, was also normal.
But it often takes several hours for evidence of a heart attack to show up in blood enzymes.
Doctors performed other tests and discovered a branch of his left anterior descending artery was nearly completely blocked. They threaded the stent through a blood vessel in his leg and used it to force open the artery.
Reiner said the device is like "a tiny, stainless steel scaffold." As a tiny balloon inflates, it expands the stent to force open the artery.
Doctors performed a second blood test about noon. It showed enzyme levels were abnormally high, indicating Cheney had a small heart attack, doctors said.
In the meantime, as Cheney was undergoing surgery, campaign officials were assuring the nation that he was fine.
About noon, Texas Gov. George W. Bush told reporters, "Dick Cheney is healthy. He did not have a heart attack."
In a brief exchange with reporters, Bush four times used the word "strong" to describe Cheney.
Asked later if Bush misled the nation, campaign officials said the governor did not know that Cheney had a heart attack until the late afternoon.
About 2:30 p.m., Wasserman held a briefing in a university auditorium in downtown Washington. He read a carefully worded statement that gave the impression Cheney had not suffered a heart attack. Wasserman initially said Cheney came for "chest pain" but corrected himself and said it was for "chest discomfort."
Wasserman said "neither his initial EKG nor blood work indicated he had had a heart attack."
It was not until the second half of his statement that Wasserman dropped a clue that doctors knew that a heart attack had occurred. He said a second set of enzyme tests "was minimally elevated."
Only after reporters consulted with cardiologists away from the news conference did it become evident a heart attack may have occurred.
About 5 p.m., the hospital's doctors held a second news conference to acknowledge they had known that Cheney suffered a heart attack.
Asked if he misled reporters, Wasserman said "I assumed that most people would understand (high enzyme levels) meant a small heart attack."
Dr. John F. Williams, vice president for health affairs at the hospital, said the Bush campaign had not been consulted about the statement. But he said it had been written in consultation with Cheney's wife, Lynne, and his daughter Elizabeth.
"We never attempted to mislead the press or the American people," Williams said.
Speaking in a strong voice, Cheney told CNN's King that he wasn't scared when he decided to be taken to the hospital from his Virginia home.
"It's one of those things where I'd learned, had drummed into me properly over the years, that any time you feel something that might be cardiac-related, you go check it out," Cheney said.
For months, Bush campaign officials have refused to release data on the strength of Cheney's heart. But on Wednesday, the doctors relented and said his "ejection fraction," the amount of blood his heart pumps out on each beat, is 40 percent. A normal heart pumps about 65 percent of its blood per beat, said Dr. John C. Dormois, a Tampa cardiologist.
A 40 percent rate suggests that Cheney is not in immediate danger of cardiac arrest, but his heart also cannot be described as healthy, said Dr. Vibhuti Singh, an interventional cardiologist with St. Petersburg's Suncoast Medical Group.
The doctors at George Washington University said Wednesday that there appeared to be no link between the heart attack and any stress Cheney may have been feeling about the election results.
They said his prognosis is good because he exercises and eats relatively healthy meals.
"I would expect him to return to a very normal and vigorous lifestyle," Reiner said, adding that Cheney needs to lose weight.
Dormois, the Tampa cardiologist, said, "This guy is pushing the envelope in a sense. He's lived a long time with a deadly disease, and that's great. But the longer one has it, the greater the risk of complication."
- Information from the Associated Press was included in this report.
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