Bush's Heart Scare

A sudden arrhythmia raises questions about his health-and Quayle

He was well into a long jog on a lovely late spring afternoon when the symptoms set in. As President George Bush loped along the woodsy trail at Camp David, he felt unusually fatigued and short of breath. Signaling the Secret Service men trotting alongside, the president headed for the bucolic retreat's well-equipped infirmary only a few hundred yards away. The White House physician on duty, Dr. Michael Nash, detected an irregular heartbeat-atrial fibrillation and ordered his commander in chief to board a helicopter to Bethesda Naval Hospital.

The president never lost consciousness or even complained of pain. According to White House spokesman Marlin Fitzwater, he asked to have his briefcase put aboard the chopper, and fiddled at paperwork on the short flight in. After an electrocardiogram and an ultrasound test, he was sitting up in bed, eating a steak and jawing with his wife, Barbara. The White House played down the episode. By 8 p.m., Fitzwater was telling reporters that the president was in "good spirits," while the medical reports were "very positive" (box). The president would spend the night to await the results of his tests, but expected to head home in the morning. It was all intended to reassure an anxious public.

But the fear was not so easily dispelled. At 66, Bush had seemed so fit that few bothered to worry whether he would survive his term in office, or a second term that has seemed to be his for the asking ever since Operation Desert Storm sent his popularity soaring higher than any president in modern times. The White House blandly reported that after arriving at Bethesda Naval, Bush had talked with Vice President Dan Quayle, telling his No. 2 that he felt fine. But reporters immediately began wondering what Bush's health scare would do to Quayle's already shaky standing. With Quayle's favorable rating at 19 percent, a record low, there are sure to be questions about whether this is the man most Americans want a heartbeat away from the presidency. Immediately, the speculation began that Quayle would be bumped from the GOP ticket in '92. "Quayle's a luxury we can no longer afford," cracked one administration staffer. Such talk was premature, not to say morbid, but, in the harsh world of polities, inevitable.

At 6 feet 2 inches, 195 pounds, Bush has long been a picture of rosy good health. He invariably emerges from his annual checkups waving the thumbs-up signal. "Perfect health. Feeling good," he declared in March after a six-hour examination. "He is in remarkable, robust health," said Dr. Larry Mohr, the deputy White House physician. Many men in their 60s would envy his cholesterol level (192, in the "desirable" range) and blood pressure (a normal 108 over 84).

Before he took office, Bush had not been hospitalized in 25 years. As vice president, he never missed a day at the office, succumbing only to "24-hour viruses" on a few weekends. As a Navy lieutenant back in World War II, he hated getting shots, fainting once at the sight of a "great big needle." Since then, he has rarely needed medical attention. An allergy to bee stings made him swell up and feel short of breath at a football game in 1978, and he suffers from hay fever at pollen time. In 1986, he had a small skin cancer removed from his face, and he is under orders to wear a hat in the sun. Two weeks after he was inaugurated in January 1989, Bush came down with laryngitis and was required to restrict his conversation for a day, a true hardship for Bush. His other ailments have been equally prosaic: in October 1989, the president had a benign cyst removed from his right middle finger, and a year ago he was diagnosed with very mild glaucoma. Bush, who stopped wearing contact lenses because they irritated his eyes, treats the eye condition with daily drops. Like many men over the age of 60, Bush has a mildly enlarged prostate and had a benign polyp removed from his colon.

More than 20 years ago, Bush had trouble coping with stress and suffered from ulcers. But now he says he no longer lets troubles "eat me up" or "drive me up a wall." His solution is one employed by generations of WASPs: plenty of exercise and a martini or two now and then. Bush sometimes seems to eat like a child and play like a teenager. His gusto for junk food was a standing joke among reporters during the 1988 campaign. He hates vegetables and in the final days of the campaign ordered stewards on Air Force Two to stop serving broccoli. Last week Bush dined at Washington's Palm Restaurant and ate a large steak, fries and onion rings.

Bush says the key to robust health is "don't eat too much, don't drink too much, and exercise." The president is well known as a manic sportsman. Vacations at Kennebunkport or weekends at Camp David are consumed with a marathon of sports: tennis, golf, skeet shooting, paddle ball, speedboating and fishing. Bush's latest enthusiasm is a game called wallyball-volleyball played on a racquetball court. Leaping about, Bush routinely wears out younger Secret Service men and White House aides. The higher the tension, the harder Bush plays. During the first weeks of the Persian Gulf crisis last August, Bush played what his aides called "aerobic golf." Practically running from shot to shot, he finished 18 holes in under an hour and 45 minutes, which may be some kind of record.

As he boarded the helicopter to Bethesda Naval Hospital last weekend, Bush's only complaint was that he had to interrupt his jog. Depending on how his tests turn out, no one will be surprised to see Bush jogging-and putting, pitching, lobbing and serving-again before long. But any heart episode is scary, a reminder of mortality. Even the fittest can be quickly struck down. Jimmy Carter was an inveterate jogger, too, but photographs of him staggering from exhaustion in a footrace, gray and weak, cast a symbolic pall over his presidency. Bush's scare is a reminder that normal blood pressure and a high popularity rating are no guarantee of longevity. For a nation in need of strong leadership, that is a sobering thought.

BARBARA KANTROWITZ With GREGORY CERIO and MARY TALBOT

When the heart is in a state of atrial fibrillation, it essentially loses its commander in chief: the electrical impulses in the upper heart chambers (the atria) that regulate the heartbeat. The heart suddenly beats very rapidly up to 150 times a minute, compared with a normal rate of about 6O to 100 beats a minute. The patient feels a shortness of breath, a pounding sensation and weakness. Although the condition can be temporarily debilitating, it is not usually life-threatening in itself, cardiologists say. The real threat comes from the cause, possibly heart disease, thyroid irregularities or pneumonia. "Appearing suddenly in a 66-year-old man, it has to be taken seriously," says Dr. Isadore Rosenfeld, a Manhattan cardiologist.

Doctors' first step is to slow down the heartbeat, usually with drugs such as digoxin, which President Bush is reportedly taking. Once it has slowed, the heart frequently slips back into a regular rhythm on its own. If it doesn't, electric shock is often used to kick-start the heart.

Cardiologists next try to find out what caused the problem. Like Bush, the patient gets an electrocardiogram to see if there is underlying heart disease. Bush's doctors found no problems other than the irregular rhythm. Bush also had an ultrasound examination of his heart to detect any structural problems; there were none reported.

Blood tests, which take at least eight hours to complete, determine through the presence of enzymes whether a section of the heart was deprived of oxygen long enough for any tissue to die. Later, the patient may undergo a stress test to reproduce the conditions under which he experienced the fibrillation. He may also have an angiogram, in which dye is injected into the coronary arteries to cheek blood flow. "Arteries can rupture suddenly," says New York cardiologist William Schwartz. "You can do a stress test one day and be fine, and arteries can tear the next."

Bush's condition is common. According to the American Heart Association, a million Americans suffer from atrial fibrillation. It can be a one-time occurrence, in which case the outlook is excellent. However, if the arrhythmia proves to be chronic, then the patient could require blood thinners to diminish the risk of a blood clot.

Cardiologists say Bush could have had the arrhythmia for some time, and not have noticed it until his heart was under exertion while jogging. His physicians did not detect it during his last exam, on March 27. But if there's no basic damage to the heart, doctors say his prognosis would be excellent and he could resume normal activities soon. That would be the best medicine of all.

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