Cheney suffered ‘mild heart attack,’ tests show

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Tests on former Vice President Dick Cheney, who was said to be resting comfortably after being admitted to a hospital overnight suffering from chest pains, showed “evidence of a mild heart attack,’’ an aide said. This would represent the fifth heart attack for a longtime and now retired political figure in Washington who has served at the White House of four presidents and as a congressman from Wyoming. Cheney served as an adviser or Cabinet-level official in the administrations of three Republican presidents and as vice president to former President George W. Bush for two terms. Cheney, 69, wears a pacemaker and has had four previous heart attacks, the first at 37 years old. He has had quadruple-bypass surgery and two artery-clearing angioplasties. Cheney aide Peter Long issued a statement today about the results of lab tests at George Washington University Hospital, where Cheney underwent a stress test and an unspecified heart procedure. He said Cheney was expected to be released from the hospital by the end of the week.

[Updated at 1:40 p.m.: Five heart attacks may seem like a lot, but experts say that’s not necessarily the case. Physicians have become better at diagnosing very small heart attacks that might have passed unobserved in the past, and improvements in therapy have made large, killer heart attacks less common.

The tests for cardiac enzymes released during a heart attack have become very sensitive “and can pick up a very small amount of heart damage,” said Dr. Gregg Fonarow of UCLA’s Reagan Medical Center. “If the attacks are very small, there would not necessarily be any substantial impairment of heart function.”

At the same time, improved treatments for heart disease mean that many heart attacks are smaller than they would have been a generation ago. Drugs to prevent clotting, reduce cholesterol, lower high blood pressure and dissolve clots that cause attacks have reduced the likelihood of a massive attack in someone with diagnosed heart disease. “With aggressive medical therapy, we don’t see the very big heart attacks we used to have 20 years ago,” said Dr. Robert Kloner of USC’s

Keck School of Medicine. “People can have small heart attacks multiple times and still do very well.”

One factor that may be operating in Cheney’s favor is that he has suffered heart problems since 1978. Over that time, “it is likely that he has developed collateral blood vessels that grow into the areas not getting enough oxygen,” Kloner said. “That might be something that is helping him.”

So how many heart attacks can one person have and still survive? The answer depends on the amount of damage to the left ventricle, which pumps blood out into the arteries. Problems arise when about 40% of the muscle in the ventricle is damaged.

That may require a transplant or other drastic measures. Cheney’s physicians have not revealed any information about the condition of his ventricle.

Apparently, no records are kept for individuals with the most heart attacks during their lifetime. But Fonarow said he has had patients who have had eight or nine and are still going strong.]

-- Mark Silva and Thomas H. Maugh II