13 September 2004

--- The Bill Clinton Heart Bypass

When former US President Bill Clinton had his quadruple heart bypass last week, it was all over the news. He suddenly became the world's famous heart patient. It is good publicity for cardiologists when important people undergo surgical procedures aimed to prevent future heart attacks. It puts the subjects of heart disease, heart attacks, and questions like how to prevent them and what to do when you begin having chest pains, on the minds of people who, more often than not, are taking their symptoms for granted. Most people --- and I hope you won't sound surprised or hurt with this reaction --- are often ignorant or prefer to be ignorant of significant heart symptoms until it is too late.

Bill Clinton is one lucky guy. Not because he seems to have gotten away with the Monica incident (and even got paid a handsome price writing a book about it!), but because he is another case of a possible heart attack case that was prevented. Before the bypass, Clinton experienced chest pains (medical term is angina) and shortness of breath which prompted him to have an angiogram, which is a radiologic test that maps the arteries in one's heart, and tells the cardiologist if a bypass is necessary or not. The procedure is called a "bypass," because that is essentially what a cardiothoracic surgeon does: he bypasses the clogged heart vessel(s) by getting a healthy vessel in another part of the body and transplanting it to the diseased heart. In Clinton's case, his heart surgeon, Dr. Craig Smith, got blood vessels from Clinton's chest wall and one leg to serve as bypasses for the diseased heart arteries of the former president.

Cardiologists consider the angiogram as the gold standard of all heart tests. One might pass the ECG, the stress test, the Holter, the calcium scans, and the lipid profile lab tests, but an angiogram's result will tell if there is significant blockade of the heart vessels. In a TIME magazine account, the magazine's resident doctor-columnist, Dr. Sanjay Gupta, warns that angiograms are not exactly risk-free.
"In about one case out of 1,000, according to Dr. Richard Stein, associate chairman of medicine at Beth Israel Medical Center in New York City, there are complications --- including, in rare cases, strokes. For patients who have never had any symptoms (such as the chest pains and shortness of breath that Clinton experienced) and whose stress tests are normal, the risks outweigh the benefits, says Stein."[TIME.com]
Instead, he opts for a noninvasive test called electron beam computed tomography (EBCT), which "uses a burst of X-rays to show how much calcium has been deposited in the coronary arteries --- a good measure of how much plaque has accumulated there."

In the US, there's a phenomenon happening now which American newspapers call a "Clinton syndrome," an event described as a case wherein "worried, middle-aged men (are) wanting tests for chest pain and other possible heart disease symptoms." There was a noted increase in physician calls and appointments among American men who thought they were vulnerable and possible heart attack candidates.

Does it sound amusing?

You know people. They just have to be stimulated first before taking action.

But I want you to get this "heart-attack-scare" from a proper perspective. While it is true that a healthy lifestyle --- you know the drill: right food, enough exercise, less stress, no smoking, etc. --- might help prevent a heart attack, it is not a fool-proof solution.

Consider the lives of Patient A and Patient B.

You can have a young patient A who exercises, eats the right food, who does not smoke, and still suffers from a heart attack.


Don't be. There is a very good account of that kind of case from a heart bypass patient himself in this link from the UK's The Independent. I strongly recommend you read his story. It is an eye-opener for the soon-to-be-initiated heart bypass candidates.

Conversely, you might be like patient B who feasts on cheeseburgers,quarterpounders, fries, slabs of steak, smokes as if he's a chimney, lives the life of couch potato who has the TV remote for a bestfriend, and --- drumroll, please --- still emerges with a healthier heart and a longer life than the patient A who was extra careful about his lifestyle. Eventually though, a heart attack will probably finish off his hedonistic tendencies.

Life can truly be unfair that it sucks sometime, or most of the time, depending on how you look at it.

The key factor is always our genes. In Clinton's case, he had a family history of heart disease, and while he was a former US president and "probably the most health-checked man on the planet," who passed his ECG, stress tests, and lipid tests, he was not able to escape his fate: he still developed clogged heart arteries.

It is hard to escape your destiny, especially when it is etched in your genes.

In my case, having also a strong family history of heart problems and stroke, I have ECG, the stress test, and the lipid profiles done yearly. I have not had that angiogram (yet!) for two reasons: I don't have chest pains (yet!) and my cardiologist hasn't suggested it (yet!).

Heart problems are in my genes, and might be in yours, too, so we have no choice but to be vigilant. I'm also on statins guys, so you're not alone.

Even the doctor is also a patient himself.

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