Just How Bad Was It?
Dick Cheney's heart condition has been the subject of speculation
and controversy from the moment George W. Bush picked him as his
running mate. Cheney had suffered three heart attacks in 10
years, his first at age 37, and in 1988 underwent
quadruple-bypass surgery to relieve blockages in his coronary
arteries. From a medical perspective, the news last week that he
had suffered a fourth heart attack wasn't all that surprising.
Indeed, Cheney is so attuned to the vagaries of his heart that
when he was awakened last Wednesday around 3:30 a.m. by a
discomfort in his chest, he realized at once that he couldn't
dismiss it as simple indigestion. It wasn't intense pain, Cheney
told the press two days later. But, he said, "it lasted long
enough, it was steady enough, it didn't change when I breathed
deeply or moved around" that he decided--correctly--to have it
checked without delay. (See this week's Personal Time: Your
Cheney arrived at George Washington University Medical Center at
4:30 a.m., and shortly afterward, doctors performed an
electrocardiogram and a blood test. The ECG, which looks at how
well the heart is beating, showed no change from Cheney's
previous ECGs. The blood test, which measures the presence of
special enzymes released by the heart during a heart attack,
showed no evidence yet of any damage. But doctors know it often
takes several hours for cardiac enzymes to show up in the blood
after a heart attack, so follow-up tests were ordered.
After a second ECG at 7 a.m. revealed minor abnormalities,
Cheney's doctors decided to take a closer look at his coronary
arteries. A dye was injected into his blood vessels and an X ray
delivered the bad news: a branch of Cheney's left descending
artery--one of the three main arteries in the heart--was about
The next step was to thread a tiny surgical balloon and a thin
stainless-steel stent into the artery to forcibly widen the
passage. After the balloon was deflated, the metal mesh of the
stent was left in place to keep the artery open. During this
procedure the results from Cheney's second blood test became
available. It showed a slight increase in the cardiac enzymes,
indicating that Cheney had suffered a mild heart attack after
Based on everything that's known so far, it seems Cheney is in
pretty good shape for someone who has had four heart attacks;
there is no reason to think he wouldn't be able to serve one or
even two terms. Over the long haul, says Dr. Christopher Cannon
of the Brigham and Women's Hospital in Boston, the goal should be
to prevent future episodes through more aggressive lowering of
cholesterol and treatment with more anticlotting agents. But it's
hard to know how much more Cheney's doctors can do, since basic
questions about his treatment have not been answered.
Despite repeated requests for information, his doctors have
declined to say much about the four bypass grafts that were
stitched into Cheney's heart 12 years ago. Typically, such grafts
last 15 years or so before they have to be replaced.
Cardiologists trying to read between the lines of the press
releases assume his grafts must be holding up, because the stent
was not placed in a bypassed artery.
Cheney's cholesterol level has never been disclosed; doctors have
said only that it is being treated. His estimated 40% "ejection
fraction," a measure of how efficiently his heart is pumping
blood, suggests that Cheney's heart is "moderately impaired,"
according to Dr. Roger Blumenthal of Johns Hopkins Hospital in
Baltimore, Md., and it places him at somewhat higher risk for
another heart attack.
But, Blumenthal is careful to add, it doesn't preordain another
heart attack. "He should look at this episode as a wake-up call,"
Blumenthal says. Losing weight, eating right, keeping his blood
pressure low and exercising more are all steps that should help.
Most doctors also advise heart patients to minimize stress, but
stress is one thing Cheney will have a hard time avoiding--at
least for the time being.
--By Christine Gorman. Reported by Alice Park/New York