Doug Mills  /  AP
President Clinton goes for a morning jog on the Mall in Washington, in this May 21, 1993 photo. Clinton checked himself into a New York City hospital on Friday suffering from chest pains, officials said.
updated 9/7/2004 5:56:24 PM ET 2004-09-07T21:56:24

Bill Clinton is a man close to 60, with a little pudge and a longtime love of junk food. That fits the stereotype for heart disease.

Needing bypass surgery, however, suggests that the former president’s disease is relatively extensive, and that’s surprising for an active dignitary who presumably has top-notch and timely physical checkups.

Clinton is fortunate that his chest pains sent him to the doctor. Far too often, the first symptom in people who don’t fit the stereotype is a heart attack or sudden death.

Blockages in several arteries
To feel chest pain means at least one important artery is 70 to 80 percent blocked. Tests showed Clinton had not had a heart attack, but did have blockages in several arteries.

That means he wasn’t a candidate for less invasive treatments, in which balloons and stents are threaded into arteries to clear them out and prop them open. Clinton needs open-heart bypass surgery.

The good news for Clinton is that nonemergency bypasses, like the one he has scheduled, are very safe. Moreover, patients leave the hospital armed with medications that, together with good diet and exercise, dramatically lower their risk of a future heart attack or even more surgery.

“With statin drugs and other measures, patients are going much longer, beyond 10 years, without the need of a second operation,” said Dr. Charles Rackley, a cardiologist at Georgetown University Hospital. “He’s got a lot to look forward to.”

Heart bypass surgery common in U.S.
Some 305,000 Americans had heart bypasses in 2001, the latest data from the American Heart Association shows.

It’s arduous surgery: It requires general anesthesia. Usually, the patient’s heart is stopped and a heart-lung machine circulates blood, although about a fifth of bypasses now are performed on a beating heart. That makes the procedure more challenging for the surgeon.

The chest is cut open, and surgeons attach new blood vessels to create a detour around clogged ones. Usually, that requires cutting a donor vein from the leg, which gives the patient another body part to heal.

The operation’s risk of death is less than 1 percent for a stable patient with normal heart function, like Clinton, Rackley said.

Patients typically spend three to five days in the hospital, including a day in intensive care where they wake up groggy and with a breathing tube. Once they can breathe on their own and feel up to it, walking is encouraged; more active rehabilitation is prescribed a few weeks after they go home.

Many patients can be back to work in four to six weeks. Recovery sometimes takes longer, however, particularly for heart-attack victims and people with physically strenuous jobs.

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How heart disease can creep up
Clinton is a good example of how heart disease creeps up.

By middle age, everyone has some fatty buildup, called plaque, in the arteries.

Age aside, Clinton has other risk factors: heart disease in his mother’s family, too many pounds and occasional periods of borderline high cholesterol. Plus that love of junk food.

Consequently, Clinton has said that he long had heart checkups, and he kept active, keeping his blood pressure and heart rate good, while he was in the White House. More recently, he lost a significant amount of weight, all important steps to good heart health.

Still, heart symptoms can appear suddenly, even in people who recently sailed through checkups. In fact, half of all heart-attack victims have normal or low cholesterol levels.

“We think of it (heart disease) like crud building in a pipe, and it’s more complicated than that,” explained Dr. Jonathan Halperin of Mount Sinai Medical Center in New York, a spokesman for the American Heart Association.

Instead, inflammation deep in the body can suddenly trigger an artery blockage even when there is little overall fat buildup, by breaking apart plaque so that it forms clots to choke off blood flow.

So if chest pain suddenly begins, even if you just passed a checkup, follow Clinton’s example and see a doctor right away, Halperin says.

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