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Dr. Richard Pasternak on the vice president's heart test procedure



Dr. Richard Pasternak is the director of Preventive Cardiology and Cardiac Rehabilitation at the Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School.

CNN: Vice President Cheney announced that he'll be undergoing more testing for his heart condition. What can you tell us about the procedure he is scheduled to undergo?

PASTERNAK: I need to start by saying that I'm not directly involved in his case. All I know about what he'll have done tomorrow I've learned through reading the news. My understanding is that he'll have a cardiac catheterization, similar to what he's had in the past, but the purpose of this procedure is to evaluate a possible electrical problem. In the past, his catheterization has been for coronary artery flow problems. According to my understanding at this point, he was aware of a rapid heartbeat, and that led his doctors to do what's called a Holter monitor, and that study, which involves wearing a tape recorded electrocardiogram around for a day and half, showed that he was having very brief periods of a rapid heart rate. Based on that, his doctors seem to have decided that it's important to see if these rapid heartbeats could be the kind that occasionally are dangerous. This is evaluated through a procedure called an electrophysiologic study, where tubes and thin wires are placed into the heart, and the electrical patterns are monitored. My understanding is that if the diagnosis of a certain kind of arythmia occurs, they will then proceed to insert what the vice president has called a "pacemaker plus." This is a commonly used, but advanced pacemaker known technically as an implantable cardioverter defibrillator, or ICD. This device can both speed the heart up, if it's going too slowly, and can detect an abnormal fast rhythm, and deliver a small shock to correct that rhythm.

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CHAT AUDIENCE: Is there a risk of inducing a heart attack with this procedure, albeit in a controlled environment?

PASTERNAK: Generally, there really is not a risk for heart attack with this procedure, because in most cases, this is done on the right side of the heart, not the left side where the coronary arteries are. Occasionally, catheters need to be inserted into the right and left ventricles. When that occurs, the risk is slightly higher, but still very low.

CHAT AUDIENCE: Dr. Pasternak, how common is it for a heart to beat at an uneven pace? Should you feel it?

PASTERNAK: It's fairly common after people have had heart attacks, to have abnormal heart rhythms. Most are completely benign. Sometimes they are sensed by the patient, sometimes they are completely asymptomatic. When the patient notices these, the doctor will usually look a little further, usually by wearing the tape recorder around to check the rhythm.

CHAT AUDIENCE: Does the VP have a "mitral valve prolapse" ? I have experienced that myself and it is no fun -- I have had several instances of rapid heartbeat. Does the VP have this problem?

PASTERNAK: I don't know if he does or not. None of the reports I've seen indicated that he does. In general, the rhythm that the doctors seem to be concerned about is one associated with prior heart attacks. Mitral valve prolapse can also be associated with rhythm disturbances, such as the one you might have had, but in the case of mitral valve prolapse, while these rhythms can be disturbing, they're generally not at all dangerous.

CHAT AUDIENCE: With this pacemaker, will he be limited where he can go with all kinds of electronic equipment in the White House and his office?

PASTERNAK: I don't know the answer to that question. It is true that people with these devices do "set off" metal detectors at airports and other places where security is high. But that should not interfere with the device, and I'm sure that's an issue that could be easily dealt with. I'm sure that others in the history of White House security have had pacemakers, and this problem has been seen before.

CHAT AUDIENCE: Why isn't Cheney just being put on a drug like Tenormin?

PASTERNAK: Again, all I know about the vice president's care is what I read in the various news reports. He may well already be on a drug like Tenormin or a beta blocker.

CHAT AUDIENCE: Dr., this procedure is performed every day in many hospitals all the time - no big deal --unless you are the vice president, right?

PASTERNAK: Yes, it's frequently performed in medical centers where there are experts in electrophysiology. Any time any procedure like this is performed, some people will consider it a big deal, particularly those having the procedure. But it is a safe procedure, and in the setting where experienced hands are involved, a very routine one.

CHAT AUDIENCE: Doctor, isn't the big problem when the rapid heart beat tries to regulate itself he goes into arythmia, and he skips beats and could have a heart attack if his heart is already weak?

PASTERNAK: There are a lot of questions in that question. The real risk of what I'm sure his doctors are concerned about is that a sustained rapid heart beat like this can decrease the amount of blood the heart can pump, and individuals can lose consciousness. Clearly, nothing like this has happened to the vice president, but when this arythmia occurs over a long time, it becomes dangerous, because the heart simply can't pump enough blood.

CHAT AUDIENCE: Is it true that some of the leads to the pacemakers cause problems to some people?

PASTERNAK: It's not an issue that I've ever heard anything about, and I'd be surprised if that were a significant problem. I'm sure that the pacemakers themselves do not have any exposed lead, although it may be involved in some of the internal battery components.

CHAT AUDIENCE: Do you think the stress of his work is contributing to these problems and if it were anyone else, would you recommend they retire or go out on disability?

PASTERNAK: Stress is always a factor in all kinds of heart disease, but the goal of modern therapy is to provide treatment that will allow virtually anybody to lead the kind of life that they would like to. And certainly, as far as I understand the current problem, this is not one which would lead me to recommend that a patient like the vice president do anything other than continue to actively pursue the work that he wishes to.

CNN: Do you have any final thoughts for us today?

PASTERNAK: Like everyone, I'm wishing the best to the vice president. We'll be following the case with great interest.

CNN: Thank you for joining us this morning, Dr. Pasternak.

PASTERNAK: It was my pleasure to be with you. Bye everybody.

Dr. Pasternak joined CNN.com via telephone from Boston, MA. CNN provided a typist for him. The above is an edited transcript of the interview on Friday, June 29, 2001.





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