Dr. J. would like to wish President Bush a healthy and rapid recovery from his angioplasty and stenting today.
|This is an example of primary stenting of a type A lesion, no pre-dilation with a balloon. Easy peasy apple squeezy.|
Mr. Bush had his annual physical on Monday and underwent stress testing. It is not clear from the news that the stress test was for symptoms or an abnormal EKG*, or that his doctors just did it to do it because he’s the former President and ordering tests is what people expect their doctors to do, after all the executive physical with an annual stress test is de rigeur on Mad Men, right?
Anywho, the blinkin’ test was positive so today, he underwent cardiac catheterization. They found one of his three main coronary arteries (the left anterior descending, left circumflex, or right coronary artery) to have a narrowing corresponding to the ischemia generated by the stress test and he had a stent placed.
In addition to the stent, Mr. Bush will be placed on a mediation regimen that will include aspirin indefinitely, clopidogrel (Plavix) for a year, a statin such as simvastatin indefinitely, and possibly a beta blocker such as metoprolol for two years.
In his case, these medications, not the aforementioned stent** are the interventions that have been shown to reduce risk of future heart attacks and cardiovascular death in patients with coronary artery disease. Indeed, if he didn’t get the stent, his risk of a future heart attack would be about the same. The stent makes any underlying chest pain symptoms go away faster than medicine to treat the chest pain symptoms. The 70% blockages don’t cause heart attacks, the 0-30% narrowings can, should they rupture and a clot form. By the time they are more than 50%, they are less likely to rupture.
But how did this happen? President Bush is incredibly fit, doesn’t smoke, lives a clean life. Was it the stress of the Presidency!??!?!
There is a whole body of literature on stress, but at most, it’s a non-traditional risk factor that’s both tough to quantify and tough to see if there’s an intervention that improves outcomes in that population. Back in the Mad Men era (well, the early 70s, anyway), Papa J. had his big heart attack and the ‘Executive Type A personality’ was medicated with oxazepam (Serax) a gentle sedative like Valium or Ativan. It didn’t save lives or reduced events so they stopped doing it. It made him snooze for a little bit after dinner.
|After, did he age eight years, or more?|
Yes the presidency ages you, but Dr. J. thinks that Dubya weathered the storm a little better than President Obama has.
|He’s on the right, but even in five years he’s a little more worn. If he was the guy on the left, then Newsmax’d be right for once.|
** This assumes he did not have a non-standard of care left main coronary artery stent placed in lieu of bypass surgery.