Cheney Suffers a ‘Very Slight’ Heart Attack

WASHINGTON —  Dick Cheney, the Republican vice presidential nominee, suffered what physicians described as a “very slight” heart attack Wednesday and underwent surgery to improve blood flow to his heart, providing yet another breath-catching twist in the political tumult that has been churning since the election.

Initially, doctors and George W. Bush declared that Cheney, 59--who has a history of heart trouble--did not have a heart attack. But doctors revised their diagnosis after a later set of blood tests indicated a “minimally elevated level” in heart muscle enzymes. The presence of these enzymes indicates heart muscle damage--a heart attack.

In a brief telephone interview on CNN’s “Larry King Live” Wednesday night, Cheney said, “I feel good and everything’s looking good.” He said taking the precaution of going to the hospital at the first sign of trouble “is one of the things that I’ve learned over the years. Anything that might be cardiac-related, you have to check it out . . . . That’s good advice for everybody.”

Cheney’s health was the focus of much attention when Bush selected him last summer to be his running mate. At that time, Cheney had suffered three heart attacks, the first at age 37. He underwent quadruple bypass surgery in 1988.

On Wednesday, in explaining the change in their earlier diagnosis, doctors stressed that the definition of heart attack was changed last year by the American Heart Assn. to reflect “any enzyme elevation” measured in the blood.

“Over a year ago, this amount of enzyme elevation would not have been considered by most people signs of a heart attack,” said Dr. Alan Wasserman, professor of cardiology at George Washington University Hospital, where Cheney--experiencing chest discomfort--checked himself in before dawn Wednesday.

“To put this into some perspective, in someone that has had a significant heart attack, the levels would be somewhere 20 to 50 times higher,” Wasserman added.

On Wednesday, physicians performed a cardiac catheterization, inserting a permanent stent--a tiny scaffolding-like device--to widen a narrowed artery.

The Bush camp sought to downplay the potentially serious nature of Cheney’s hospitalization, putting a positive face on his condition and his prognosis and initially insisting--based on doctors’ views early in the day--that Cheney had not suffered a heart attack.

Bush, speaking to reporters in Austin, Texas, said: “We had a very good conversation. He sounded really strong. Secretary Cheney will make a great vice president . . . and America is beginning to see how steady and strong he is.”

“Dick Cheney is healthy,” he added. “He did the right thing. . . . Anybody who’s had heart conditions will tell you if there’s any signs, any warning signs at all, it’s important to have it checked out, and that’s what he’s done.”

Bush and his aides dismissed questions about the stability of the GOP team, and whether they were considering alternatives should Cheney’s condition keep him from serving.

Asked whether it would be prudent to have a backup nominee, Bush spokeswoman Karen Hughes replied: “No, it’s not.” She added that Cheney has had similar pains in recent years, but not since Bush picked him to be his running mate.

President Clinton said he hoped Cheney will be “well and fine. . . . I need to call him and write him a note.”

Doctors at the hospital said they did not believe that stress related to postelection events contributed to Cheney’s heart attack--although stress is a known risk factor in heart disease. Cheney’s heart attack apparently occurred hours after Florida’s Supreme Court decided to permit manual ballot recounts in some Florida counties, a key victory for Vice President Al Gore.

Cheney, in the CNN interview, said he had “not found the last couple of weeks as stressful as, say, the Gulf War. . . . My time in the Pentagon during the Gulf War was far more stressful.”

He added that his recent hospitalization should not affect his ability to serve as vice president. “There shouldn’t be any problems of any kind like that. Obviously, I always follow my doctor’s advice. . . . [There’s] no doubt about my serving. All we have to do is get elected.”

And he offered a joke, referring to the recounting of ballots in Florida: “I can report when they got in there they didn’t find any pregnant chads.”

Wasserman said Cheney was expected to spend two to three days in the hospital, but should have no restrictions after he leaves.

Dr. Jonathan Reiner, Cheney’s personal physician, described Cheney’s heart function as “moderately impaired,” and “consistent with his history of prior heart attacks,” stressing there had “been no change” as a result of Wednesday’s episode.

Experts called the stent procedure routine, saying it could have prevented a more serious heart attack.

Impaired blood flow through the arteries leading to the heart is a common cause of chest pains, such as those suffered by Cheney. The decreased blood flow reduces the amount of oxygen that heart muscles receive.

Balloon angioplasty is one option for remedying the problem. The procedure begins with catheterization, in which a thin catheter is inserted into a blood vessel in the groin and threaded up to the arteries leading to the heart. Physicians then inject a special dye into the arteries through the catheter and, with X-rays, locate the site of the blockage.

A small, deflated balloon is threaded through the catheter to the site. When surgeons inflate the balloon, it compresses the plaque, opening the artery to allow more blood to flow through it.

The primary long-term risk of angioplasty is that the newly reopened vessel will close down again. To prevent this from occurring, surgeons often use stents, stainless steel mesh tubes that are collapsed, inserted through the catheter, and then reopened at the blockage site. The tubes hold the blood vessel open.

Complications, which occur in as many as 10% of patients, can include minor strokes, heart attacks, the need for more surgery, or even death.

Wasserman and other experts agreed that Cheney’s decision to take himself to the hospital at the first sign of trouble was the correct move.

“His approach of early intervention can serve as a role model for all Americans,” Wasserman said.

“This is the one time when self-referral is very important because time is of the essence,” says Lameh Fananapazir, a heart disease expert at the National Heart, Lung and Blood Institute. “There are now drugs that can greatly reduce the size of a heart attack if one acts sooner, rather than later.”

After Cheney was admitted, doctors performed a series of routine tests, including an electrocardiogram and a blood test, both of which were normal. A second EKG, however, showed “minor changes,” and a subsequent blood test revealed the modestly elevated enzymes. A third blood test showed that the “levels have tapered off, and have not continued to increase,” Wasserman told reporters.

The catheterization showed an increased narrowing in a side branch artery, specifically the diagonal branch of the left anterior descending artery.

“The rest of his coronary anatomy is completely unchanged from the previous study, performed in 1996,” Wasserman said.

The two-hour procedure was performed without general anesthesia. Normally, the patient is awake and sedated.

Cheney--a onetime three-pack-a-day smoker--quit cigarettes after his first heart attack and embraced a healthier lifestyle. During the campaign, he exercised daily on a treadmill that was brought to his hotel room, and his family sought to ensure he would have only healthy food choices on the campaign plane--where food is like an all-you-can-eat buffet, and junk food is a staple.

Cheney’s “coronary anatomy has been stable for many years, and I think it’s really a testament to many of the things that he’s done in terms of cholesterol reduction and exercise,” Reiner said. “I would expect him to return very rapidly to a normal and vigorous lifestyle without really [any] restrictions.”

Cheney’s doctors gave him a clean bill of health when Bush picked him. Still, there was speculation in an already chaotic situation over what would happen if Cheney had to drop off the ticket before the electoral college meets.

If Bush were president-elect, experts said, electors would be free to vote for another Bush choice, since they vote for president and vice president separately.

If Cheney drops out before resolving who has won the election, Bush would be free to select a new running mate and the Republican National Committee would gather to ratify his choice.

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Times staff writers Edwin Chen, Megan Garvey, Robert L. Jackson and Thomas H. Maugh II contributed to this story.

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Cheney’s Cardiac Procedure

Doctors operated on Republican vice presidential nominee Dick Cheney on Wednesday, inserting a stent inside a narrowed heart artery after he entered the hospital with chest pains. The angioplasty/stent procedure is not uncommon for patients whove previously had heart bypass surgery. Cheney had quadruple bypass surgery in 1988, preceded by three heart attacks.

Here’s how the procedure is usually done: *

Sources: Staff and wire reports; Harvard Heart Letter; American Heart Assn., Cordis Corp.; Researched by JULIE SHEER /Los Angeles Times