Cheney File Traces Heart Care Milestones

Now 71, the former vice president has survived five heart attacks, the first of them at the age of 37. Even before he received a heart transplant a month ago today, Mr. Cheney had benefited from just about every procedure, technology and class of drug available to people with his condition — atherosclerosis, in which fatty deposits block blood flow in the arteries.

Indeed, Mr. Cheney’s medical history could almost be the history of medical progress against heart disease, the leading cause of death in this country and many others. Most of the advances have come during his lifetime, through taxpayer investment in research financed by the National Institutes of Health and through private investment by industry and entrepreneurs.

It was 100 years ago that doctors first diagnosed heart attacks in living patients and learned that they were not inevitably fatal. (Damage from attacks had long been detected in autopsies.) In time, doctors learned the myriad symptoms that can accompany a heart attack — among them indigestion, heartburn and, most commonly, pain in the chest, jaw and arm — and correlated them with electrocardiogram readings.

Still, for decades, doctors could do little for such patients beyond providing morphine for pain relief; digitalis to help a failing heart pump more forcefully; and oxygen tents to help breathing.

Consider President Dwight D. Eisenhower’s care in 1955, when at 64 he experienced chest pains at 2:30 a.m. while on vacation at his mother-in-law’s home in Denver. The White House physician, Dr. Howard M. Snyder, a surgeon, ordered the president’s wife, Mamie, to snuggle with her husband in bed to keep him warm. Not until the next afternoon did Dr. Snyder perform an electrocardiogram or call for an ambulance.

Eisenhower spent four weeks in bed and then three more weeks recuperating in the hospital before returning to the White House and a lightened work load. He lived with heart disease until age 78.

With the advent of electronic monitors, doctors learned to improve the treatment of dangerous heart rhythms. Such advances, in turn, led to coronary-care units in hospitals. But by the time of Mr. Cheney’s first heart attack, in 1978, much remained to be learned about treating heart disease.

About 2 o’clock one morning in Cheyenne, Wyo., during his first campaign for Congress, Mr. Cheney felt a tingling in two fingers of his left hand.

In those days, there were no warnings to call 911 for a suspected a heart attack, and Cheyenne had no cardiologist. But as Mr. Cheney writes in his 2011 memoir, “In My Time,” there was a history of heart disease on both sides of his family, and a physician-cousin had just had a major heart attack. So, he went to an emergency room. Moments later, he collapsed and was resuscitated.

A specialist in internal medicine told him to rest, exercise and stop smoking. Mr. Cheney had smoked for nearly 20 years, often three or more packs a day. When he was President Gerald R. Ford’s chief of staff in the mid-1970s, he helped himself to the cartons of cigarettes in the White House provided free by tobacco companies. Mr. Cheney’s doctor had a limited arsenal of drugs; for example, statins had yet to be widely prescribed for high cholesterol, and clot-busting drugs were not routinely used.

Mr. Cheney, who said he took the doctor’s advice, resumed campaigning and won election to Congress, mindful that leaders like Eisenhower and President Lyndon B. Johnson had served productively in office despite serious heart attacks.

His second attack came in 1984, in the Capitol Building. Although he did not feel pain, he sensed “something wasn’t right with my heart,” as he wrote, and was taken to Bethesda Naval Medical Center. After recuperating, he sought long-term care from a team of cardiologists at George Washington University Hospital.

After his third heart attack, in 1988, Mr. Cheney benefited from a relatively new procedure: quadruple bypass surgery, which though first performed in the 1960s was not widely used for a decade or so, until surgeons improved its safety.

Mr. Cheney abandoned serious thoughts of running for president in 1996 because he realized his health would be a campaign issue. Still, in 2000, George W. Bush’s team did less than intensive vetting before selecting him as a running mate. His heart did not become an issue until after Election Day: during the Florida recount, he awoke in the middle of the night with an uncomfortable sensation in his chest.

The sensation was from his fourth heart attack, which was detectable only by an improved blood test. His cardiologist, Dr. Jonathan S. Reiner, inserted a stent in a severely narrowed artery to reduce the chance of further damage.

As new classes of drugs like ACE inhibitors came along, Mr. Cheney benefited from them in combination with older ones like beta blockers, calcium channel blockers and more powerful diuretics.

While vice president, he developed additional problems, and each time he received the latest technology. For example, he had angioplasty to unblock coronary arteries; stents to keep them open; and surgery to repair aneurysms, or ballooning of arteries, behind both knees. A new combination device was implanted: a pacemaker to detect and correct abnormal heart rhythms, and a defibrillator to give a powerful electrical shock to stop potentially fatal ones.

Mr. Cheney even detected a flaw in the 25th Amendment to the Constitution that could have led to serious disruption if he had become incapacitated. Other than resignation, there is no way to remove a sitting vice president. If a stroke or a serious heart attack had left him unable to function (and unable to resign voluntarily), “I might stand in the way of the removal of a president unable to discharge his duties,” he wrote in his memoir — “or I might become an incapacitated acting president.”

So, shortly after his inauguration, Mr. Cheney wrote a letter of resignation and left it in his desk with instructions to a key aide: if he were to be incapacitated, give the letter to the president to decide whether to forward it to the secretary of state for action in accordance with the amendment’s provisions.

The defibrillator never discharged while Mr. Cheney was in the White House. But it did in 2009, in Wyoming, while he was backing his car out of his garage. And he had yet another heart attack, his fifth, in 2010 — just in time to benefit from a ventricular assist device, a battery-powered implant that helped his severely damaged heart pump enough blood to let him work, remain physically active and await a transplant. (The implant operation, at Inova Fairfax Hospital in suburban Virginia, left him unconscious for several weeks.)

The first human heart transplant was performed in 1967. Constant improvements since have made it possible to help even some people in their 70s, like Mr. Cheney. And while even the best care cannot prevent the inexorable progress of atherosclerosis in many patients, Mr. Cheney may not have run out of options. If his body rejects his new heart, he can try for a second.

Indeed, it is impossible to predict for how long the latest therapies will further extend Mr. Cheney’s life. Raymond J. Nelson, a Canadian home builder and philanthropist who at 79 received a new heart at the University of Alberta Hospital, lived with it for more than 10 years, dying in 2010 at 90. Dr. Reiner says it is not unreasonable for Mr. Cheney to expect to live another decade, a goal most doctors would have considered impossible a few years ago.

If he leads a functional life for many years, Mr. Cheney may serve as a model for older people seeking heart transplants. While that would benefit the recipients, it would add to the long waiting list for donor hearts and other organs, and to the vast sums the nation already spends on medical care for the elderly.

Mr. Cheney has not disclosed how much the transplant cost and who will pay. Medicare covers heart transplants at approved facilities.