'Nobody Expected This'

When Dick Cheney left George Washington University Hospital only two days after his heart attack last week, at least one of the election's surprise headlines seemed to fade quickly. A few hours after his minor surgery, Cheney, 59, reassured the nation on "Larry King Live" that he felt fine. At Thanksgiving the next day, he dined on turkey with his family in the hospital and phoned staffers, sounding, said one, like his usual good-natured self. By Friday morning, Cheney was smiling and out the door. "I should be able to return to a full and normal life," he insisted.

If it had to happen, Cheney's latest heart attack--his fourth in 22 years--went well from a medical perspective. He checked into GW immediately after feeling chest discomfort at dawn last Wednesday. Doctors detected a 90 to 95 percent blockage in one artery, then successfully inflated a stent to restore blood flow. Cardiac enzyme levels, which mark the extent of heart-muscle damage, showed only minor elevations. "This would be the smallest possible heart attack that a person can have," said Dr. Jonathan Reiner, Cheney's cardiologist.

Good medical news, for sure--but the episode retriggered 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. His first heart attack, in 1978, came at the age of 37, followed by one in 1984 and another in 1988, the year he had quadruple bypass surgery. According to staffers, Cheney seemed to be monitoring himself on the campaign trail, eating from a special menu and exercising on a treadmill. But he had also gained weight over the years and his heart problem was "always in the back of everybody's mind," according to one aide. Still, says Cheney spokeswoman Juleanna Glover Weiss, "Nobody expected this."

And nobody knows what to expect next. Heart treatment has improved markedly; with the right diet, exercise and medications, Cheney's prognosis could be excellent for years to come. But there are concerns. Most immediate is the stent itself, which occasionally causes clotting; Cheney is now taking a blood thinner as protection. 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. And then there's the critical "ejection fraction," which measures heart-muscle strength: Cheney's is at 40 percent--"moderately impaired," said Reiner--compared with normal levels of about 60. Given his coronary history, and the fact that the disease started when he was so young, "at some point in his life, he's going to have another heart event," says Dr. Eric Topol, chief of cardiology at the Cleveland Clinic Heart Center, who is not involved in Cheney's care. "Hopefully, it will be many, many years away."

Other risk factors could have an influence, specifically high cholesterol and high blood pressure. Doctors have not revealed Cheney's levels. Though Cheney downplayed stress, it is medically possible that it played a role: when adrenaline surges, blood-clotting cells can become sticky and clog arteries. Perhaps most worrisome, says Dr. Douglas P. Zipes, president-elect of the American College of Cardiology and also uninvolved in Cheney's case, is the possibility of an irregular heartbeat, which can be provoked by heart disease and can cause sudden death. "I don't want anybody panicking," says Zipes, "but I sure as hell would have an automated external defibrillator in his office or close by, and people who know how to do CPR."

Cheney himself sounded confident about his health and his future. "No doubt about my serving," he told Larry King. "All we have to do now is get elected."

'Nobody Expected This' | News