Area physicians differ on Cheney prognosis

Vice president's problem occurs in about a quarter of those who get stents

March 06, 2001|By Jonathan Bor | Jonathan Bor,SUN STAFF

The problem that sent Vice President Dick Cheney to the hospital yesterday just four months after his last heart attack is a common one for people who have received stents to open clogged arteries.

What this portends for Cheney and his ability to serve out his term without serious health problems is a matter of opinion, with doctors not associated with the case holding different views.

"This really doesn't represent a very significant setback for the vice president, nor does it imply that he's not doing all the right things," said Dr. David A. Meyerson, a cardiologist with the Johns Hopkins School of Medicine, reflecting the stance of Cheney's physicians.

Dr. Sidney Gottlieb, a cardiologist at the Greater Baltimore Medical Center, said yesterday's events were just the latest in a series of worrisome episodes.

"It's fair to say that those of us in the field share a concern that his heart condition is more serious than the media or the spokespeople want to indicate," said Gottlieb, a member of a large practice called Midatlantic Cardiovascular Associates.

"He's had severe coronary artery disease, he's had bypass [surgery], damage to his heart muscle and he's had more chest pain after the bypass with a blocked artery that required stenting," he said.

Cheney, 60, has had four heart attacks, including one in 1988 that triggered a quadruple bypass operation. In November, his fourth heart attack required the insertion of a stent to open an artery that was 90 percent closed.

Starting Saturday, the vice president had four episodes of "chest discomfort," according to his doctor, caused by a new blockage at the junction of the stent and the artery where it was placed. Again, the artery was 90 percent closed.

Stents are mesh sleeves, usually made of surgical-grade stainless steel, that reopen an artery that has become clogged.

New blockages form in about a quarter of all stents, Meyerson said. It is usually due to the growth of arterial tissue around the stent or to the formation of a new fatty clot.

But Meyerson, a spokesman for the American Heart Association, said it's important to note that the blockage did not form in one of the heart's three major arteries, but in a side vessel. Even if that artery becomes blocked again, it can be successfully treated and would not necessarily pose a major health risk, he said.

Cheney might eventually need a second bypass operation, Meyerson said, but not because of a new blockage in the stent. Bypass might be required if the grafts - where blood flow was diverted in the 1988 operation - become diseased.

Gottlieb said yesterday's episode cannot be seen in isolation but as a continuation of a larger condition that has caused problems for many years.

He said it is simplistic to suggest - as Cheney's cardiologist, Dr. Jonathan Reiner, seemed to do yesterday - that this latest blockage formed as a reaction to the stent rather than as a symptom of Cheney's larger problem with coronary artery disease.

"That is technically correct, but in reality it adds up to difficulty with blood flowing through the heart," Gottlieb said. "It's hard to segregate this as a different problem."

For someone with Cheney's history, even another small heart attack would represent a significant risk.

"He's already had a significantly compromised, weakened heart muscle," Gottlieb said. "Clearly a patient with this kind of history is someone we'd be very concerned about."

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