By the faculty of Harvard Medical School
Q: I was surprised to learn that former President Clinton needed
bypass surgery, and that he didn’t know he had heart disease until
a few days before the surgery. How can someone who must be getting
top-notch medical treatment not know that he has heart disease? Can
you explain the surgery he had?
By the faculty of Harvard Medical School
Q: I was surprised to learn that former President Clinton needed bypass surgery, and that he didn’t know he had heart disease until a few days before the surgery. How can someone who must be getting top-notch medical treatment not know that he has heart disease? Can you explain the surgery he had?
A: Since the 1970s, bypass surgery – formally known as coronary artery bypass graft surgery, or CABG – has been one of the best-known treatments for heart disease. More than half a million Americans have this procedure each year. The operation can dramatically improve quality of life and life expectancy for some (but not all) people with blockages in their coronary arteries. Coronary artery disease is the most common form of serious heart disease. President Clinton apparently had major blockages in four different arteries – severe coronary artery disease – and didn’t know it until just a few days before his surgery.
How did President Clinton suspect that he might have coronary artery disease? It can be hard to tell. Even with severe blockages in the arteries of the heart a person can have no symptoms or very subtle symptoms.
The symptom that most people know can indicate heart disease is a squeezing pain in the middle of the chest that can travel to the neck or shoulder. It often occurs during exercise, or when someone is very emotionally upset. When the heart muscle cannot get enough blood, particularly when it needs to pump harder (such as during exercise), it screams out in pain.
Sometimes coronary artery disease causes only subtle symptoms that can be caused by many other conditions: getting out of breath unusually easily, looking pale, feeling unusually tired, suddenly feeling faint, or having a sensation in the chest that is not really pain. Reportedly, that’s what happened to President Clinton. He apparently had been having a burning sensation in his chest during exercise. At first, he thought that his symptom was just acid reflux or “heartburn,” a condition in which stomach acid washes into the esophagus – the tube that connects the mouth with the stomach.
Like millions of us, President Clinton has experienced “heartburn” occasionally. But although the burning sensation in his chest felt like “heartburn,” he noticed that it seemed to be coming especially when he exercised, which made him suspicious that he might have heart disease. He apparently also knew that he was at risk for heart disease because his diet supposedly was heavy in saturated fats (a “bad fat”); his work and travel schedule had made it difficult for him to exercise as often as he wished; his cholesterol and blood pressure had been high; and he had been overweight. So he put two-and-two together, and did the smart thing: he called his doctor. His doctor did tests that showed he had severe heart disease, and that bypass surgery was required.
Here’s how the surgery works. A cardiac surgeon uses other blood vessels from the body (usually an artery in the chest or the radial artery in the forearm, or perhaps a small stretch of leg vein) to create a new blood supply to the heart muscle. The “new” vessel is sewn (or grafted) to reroute blood flow around (to “bypass”) the blockages. This is delicate work. A heart-lung machine pumps oxygen-rich blood through the patient’s body so that the heartbeat can be safely stopped while the surgeon completes the bypass.
After bypass surgery, the patient’s heart is started again, and he or she is taken off the heart-lung machine. Most people stay in the hospital for four to five days after the operation, though within one to two days of surgery most will probably be up and walking. Many doctors recommend a cardiac rehabilitation program after patients leave the hospital. Cardiac rehab helps patients – and their hearts – gain strength. It also teaches strategies for a heart-healthy lifestyle, including how to eat wisely and exercise regularly.
President Clinton probably had heart disease for many years before he knew it. With the surgery, the blood supply to his heart has greatly improved. The “heartburn” he experienced when he exercised should be gone, and after he recovers from the surgery he should have more energy and better color. But surgery alone is not a permanent “fix.” He has heart disease, and therefore remains at greater risk than men his age who do not have heart disease. For the rest of his life, he will need to be more careful about his diet and exercise, and to use medicines, if necessary, to control his blood pressure and cholesterol. With modern medical care and improved lifestyle, President Clinton should expect to have many more healthy years ahead of him.
Submit questions to the Harvard Medical School Adviser at www.health.harvard.edu/adviser.
