New York, NY - Despite Dick Cheney's assurances that he feels fine several days after suffering a "mild" MI, the media continue to question his fitness to serve and whether he can handle the rigors of the vice presidency. Cardiology experts quoted in the media also wonder why more information about the true condition of the former Secretary of Defense's heart has not been revealed to the general public."Reason for concern"
On NBC's "Today" show on November 27, 2000, Dr Douglas Zipes (President-elect, American College of Cardiology) says "there is reason for concern" about Cheney's heart health. "I'm concerned as a citizen as well as a cardiologist," Zipes says. "We are entitled to more information. His head works wonderfully. We want to be certain that his heart does as well."
"I'd like to know how much weight he's gained since he stopped smoking," Zipes says in a Los Angeles Times report on November 26, 2000. "I'd like to know his blood pressure and his cholesterol, and what other medications he is taking. Is he short of breath when he climbs a flight of stairs? Did his father have heart disease?"
When Cheney was released from George Washington Hospital on November 24, 2000, he told the nation he felt "great" and was "ready to resume an active lifestyle," but LA Times staff writer Marlene Cimons points out that "Cheney has had four heart attacks, the first at the relatively young age of 37. And Wednesday's attack, however mild, has been superimposed on an already damaged heart. The sobering reality about heart disease is that it can seriously affect the life and work of anyone who suffers from it, particularly in a high-stress job such as the one Cheney is seeking as George W Bush's vice president."
I'm concerned as a citizen as well as a cardiologist. We are entitled to more information. His head works wonderfully. We want to be certain that his heart does as well.
The LA Times notes that Cheney's doctors "have sought to cast his condition in a positive light, even allowing him to walk unassisted from the hospital after being discharged Friday. Most patients in his situation would have been required to leave in a wheelchair." On the "Today" show, Zipes noted that VIPs often get "reverse prejudice" because of "political expedience and popular pressures."
The upcoming Newsweek magazine on December 4, 2000 notes that Cheney's fourth MI "re-triggered concern over how much is known about Cheney's condition. When Bush picked him last July, the candidate's cardiac history was described, but one key detail-the strength of his heart-was not released until last week," writes Claudia Kalb. While Cheney's heart problem was "always in the back of everybody's mind," according to one of his aides, Cheney's press secretary, Juleanna Glover Weiss, told the magazine: "Nobody expected this."
The New York Times reports on November 25, 2000 that Cheney will take clopidogrel for 30 days to prevent clotting around the stent implanted in his coronary artery. "People around Mr Cheney have said that he has gained substantial weight since he left the Pentagon in 1993. Mr Cheney said that during his hospital stay he and his doctors discussed modifying his diet and exercise plan. He said he would continue to take a drug regularly to lower his cholesterol and to make 'minor modifications' in his other regular medications. His doctors have said Mr Cheney takes a long list of drugs, but he and his doctors have not named them," writes Dr Lawrence Altman.This won't be the last of Cheney's heart problems
Newsweek points out that "Cheney's bypass appears to have held up well so far (the clogged artery discovered last week was not involved in the original surgery), but veins likely used in the procedure often become blocked about 10 years after surgery. Cheney is now at the 12-year mark." The magazine quotes Dr Eric Topol (Chief of Cardiology, Cleveland Clinic Heart Center): "At some point in his life, he's going to have another heart event. Hopefully, it will be many, many years away."
Withdrawing from [a demanding job] can be as stressful, or more stressful, than continuing to do a job that gratifies you and makes you happy.
Stress may also play a role, even though Cheney and his doctors have downplayed it as a cause for his most recent heart episode. In the LA Times, Zipes said, "stress alters the body's functions and produces all kinds of changes. I would not discount it. Secretary Cheney has said that if he could deal with Desert Storm, he could deal with any kind of stress. But that was 10 years ago. Don't tell me you can handle anything. Things were entirely different then. And he's 10 years older." Dr Marvin Konstam (Chief of Cardiology, New England Medical Center, Boston, MA) presents an opposing point of view in the November 24, 2000 Boston Globe: "Frankly, for individuals who are used to a lot of stress, withdrawing from [a demanding job] can be as stressful, or more stressful, than continuing to do a job that gratifies you and makes you happy."
"I don't think anyone could say that his life expectancy is the same as someone who didn't have any of these problems," says Dr Ira S Ockene (Director of the Preventive Cardiology Program, University of Massachusetts Memorial Medical Center, Worcester, MA) in the Globe report. Ockene notes the timing of Cheney's recent episode - during a stressful Florida recount as part of an intense political campaign - "makes you ask yourself, why did this happen when it happened?"
Arrhythmia possibly leading to sudden death may also be a problem, add Zipes in the LA Times: "If George W [Bush] told me he was feeling palpitations, I'd shrug it off. If Cheney said so, I'd be very concerned." In the Newsweek article, Zipes suggests, "I sure as hell would have an automated external defibrillator in his office or close by, and people who know how to do CPR."
While Cheney's resting ejection fraction (EF) was finally revealed to be 40%, no one knows his EF after exercise, notes the LA Times. "If the ejection fraction rises with exercise, that's good news," says Dr Lameh Fananapazir (Head, Clinical Electrophysiology and Inherited Heart Diseases Section, National Heart, Lung and Blood Institute, Bethesda, MD). "It's quite a different scenario than if it goes down, which means that, with exercise, there is even further impairment." Glover Weiss says that Cheney's doctors would like to do a stress test "in a little while." Zipes comments that the resting EF "is only a single measure of cardiac function," which is "meaningful but insufficient" information. "I have patients with only 20% who are vigorous and have some with 35% who become short of breath with only minimal activity," he says.
Fananapazir told the LA Times that if Cheney's arteries have remained open "for a long period of time," that would be regarded as "a very good sign," especially if his EF "does not deteriorate with exercise." But, he adds, "we just don't know all the facts in his case."
[Dr Topol is the editor-in-chief of theheart.org.]
Heartwire from Medscape © 2000
Cite this: Media continue to question Cheney's health - Medscape - Nov 27, 2000.