Questions on His Fitness to Serve Surround the Tight-Lipped Cheney

He says he’s feeling great and is ready to resume an active lifestyle. His physicians paint an optimistic picture of his ability to do so.

But Dick Cheney has had four heart attacks, the first at the relatively young age of 37. And Wednesday’s attack, however mild, has been superimposed on an already damaged heart.

The sobering reality about heart disease is that it can seriously affect the life and work of anyone who suffers from it, particularly in a high-stress job such as the one Cheney is seeking as George W. Bush’s vice president.

“It’s a dreadful disease, and it’s the No. 1 health problem in this country,” said Dr. Lameh Fananapazir, a heart expert at the federal government’s National Heart, Lung and Blood Institute in Bethesda, Md.

To be sure, many people can function at a high performance level and live for many years, even with a history of heart problems like Cheney’s.

But cardiology experts noted that there is much that Cheney’s physicians have not yet told the public, particularly in the aftermath of his latest attack, after which doctors inserted a stent to open a badly blocked artery.

The missing information makes it difficult to confirm that Cheney, 59, can indeed lead as vigorous a life as he and his doctors have predicted, these experts said.

Cheney’s physicians consistently have sought to cast his condition in a positive light, even allowing him to walk unassisted from the hospital after being discharged Friday. Most patients in his situation would have been required to leave in a wheelchair.

“This guy is the potential vice president, and they’re not really telling us anything about his cardiac status,” said Dr. Douglas Zipes, president-elect of the American College of Cardiology. “I’d like to know, first as a cardiologist and then as John Q. Public.”

Refusing to Release Records

Since his selection last summer as Bush’s running mate, Cheney has refused to release his medical records or allow his doctors to be interviewed. His latest heart attack, described as “very slight” by his physicians, has renewed a long-standing debate about the pros and cons of full medical disclosure by candidates for public office.

“The physicians at George Washington Hospital have been fairly absolute in the language they’ve used to describe Secretary Cheney’s fitness,” said Juleanna Glover Weiss, Cheney’s press secretary.

“They believe his history of coronary artery disease will not impact his ability to serve as vice president or, heaven forbid, president,” she said. “Their language has been very strong and indicates that Secretary Cheney is in no way impaired to serve.”

Glover Weiss declined to respond to some of the specific questions posed by Zipes and other health experts.

Zipes cautioned that the “fishbowl” existence of elected officials--and the effect of stress--never should be minimized in heart patients. That’s no less true for a seasoned public official such as Cheney, who was Defense secretary when U.S. forces mounted Operation Desert Storm during the Persian Gulf War.

“Stress alters the body’s functions and produces all kinds of changes. I would not discount it,” Zipes said. “Secretary Cheney has said that if he could deal with Desert Storm, he could deal with any kind of stress. But that was 10 years ago. Don’t tell me you can handle anything; things were entirely different then. And he’s 10 years older.”

In one of the few specific disclosures about Cheney’s condition, his physicians said last week that his resting “ejection fraction,” a measure of the heart’s efficiency, was 40%.

If, for example, a heart takes in 200 cubic centimeters of blood and ejects 100 with each contraction, the ejection rate is 50%. The rate of a healthy heart ranges from 60% to 70% or more.

While knowing Cheney’s resting ejection fraction is useful because it is one indicator of impairment, it would be valuable to also know his ejection fraction when he is stressed during exercise, experts said.

“If the ejection fraction rises with exercise, that’s good news,” said Fananapazir, who heads the heart institute’s clinical electrophysiology and inherited heart diseases section. “It’s quite a different scenario than if it goes down, which means that, with exercise, there is even further impairment.”

Glover Weiss said she did not believe such a stress test was administered during Cheney’s latest episode but “clearly, they’d like to pursue a stress test in a little while.”

Zipes said the resting ejection fraction “is only a single measure of cardiac function,” which is “meaningful but insufficient” information.

“I have patients with only 20% who are vigorous and have some with 35% who become short of breath with only minimal activity,” he said.

He said he wishes Cheney’s doctors had discussed some of his other risk factors.

“I’d like to know how much weight he’s gained since he stopped smoking,” Zipes said. “I’d like to know his blood pressure and his cholesterol, and what other medications he is taking. Is he short of breath when he climbs a flight of stairs? Did his father have heart disease?”

An even more important question, Zipes said, is whether Cheney has had any heart rhythm problems. “Almost 25% of all deaths in the United States are due to arrhythmias, and coronary heart disease is the single most important factor in developing cardiac arrhythmias.”

An arrhythmia is any disturbance in the electrical conduction system that regulates the heart’s pumping action.

Millions of people suffer palpitations--a skipped beat or the sensation of the heart doing a flip-flop in the chest. Such arrhythmias are harmless when the heart is healthy.

But when the heart is diseased, an arrhythmia can prove deadly--and quickly.

Checkup in 1996 Yielded No Update

“If George W. [Bush] told me he was feeling palpitations, I’d shrug it off,” Zipes said. “If Cheney said so, I’d be very concerned.”

Finally, Zipes noted, Cheney’s physicians described his “coronary anatomy” as unchanged since his last work-up in 1996. But that was eight years after he underwent quadruple bypass surgery.

“His bypass was in 1988, and they did not tell us whether anything had changed between 1988 and 1996,” Zipes said.

Fananapazir said if Cheney’s arteries have remained open “for a long period of time,” that would be regarded as “a very good sign,” especially if his ejection fraction “does not deteriorate with exercise.”

But, he added, “we just don’t know all the facts in his case.”