hat Republican vice presidential candidate Dick Cheney suffered his fourth heart attack in 22 years is not unusual, Boston specialists say, but it highlights how relentless heart disease can be even in someone getting the best treatment.
Cheney, who had his first heart attack at 37, has a more aggressive form of heart disease than average, the specialists said. While this doesn't necessarily cloud his outlook for serving as vice president, it does leave question marks about his long-term prognosis.
''I don't think anyone could say that his life expectancy is the same as someone who didn't have any of these problems,'' said Dr. Ira S. Ockene, director of the preventive cardiology program at the University of Massachusetts Memorial Medical Center in Worcester.
The narrowing of an artery feeding his heart, which was treated via a catheter Wednesday, ''means that he has had progression of his coronary disease,'' Ockene said. The timing of the attack, during the stressful Florida recount following an intense election campaign, ''makes you ask yourself, why did this happen when it happened?'' he said.
The admission by doctors that Cheney had suffered a ''very slight heart attack'' led Boston experts to say he should not return to stressful work for several weeks. Also, additional tests may be in order, they suggest.
Initially, the doctors said his chest pain had been traced to a narrowed artery that deprived his heart muscle of nourishing blood flow. That would have been termed ''unstable angina,'' ''acute coronary syndrome,'' or as Dr. George Philippides of Boston Medical Center described it, ''something short of a heart attack.''
Later Wednesday afternoon, the doctors at George Washington Hospital amended their description, saying Cheney had suffered a slight heart attack. That means that a portion of heart muscle had died from lack of oxygen, just as in his previous three attacks.
The procedure Cheney underwent is common. A catheter inserted into his upper leg and snaked into his coronary arteries first released dye that would flood the arteries and reveal on an imaging device where the vessels were narrowed or blocked. His doctors said that one artery, called the diagonal branch of the left anterior descending artery, was narrowed by fatty plaque. Otherwise, they said, his arteries were unchanged from a similar test in 1996.
Then a second catheter was threaded into the artery, carrying a tiny balloon furled like an umbrella, which in turn was enclosed in a stent - a narrow metal tube. Doctors using a remote inflated the balloon, which pushed the obstructing plaque against the sides of the artery, and the stent expanded to shore up the artery walls and keep the narrowing from recurring.
Whether stress caused this heart attack and how the demanding job of vice president might figure in Cheney's future are difficult questions to answer, said Dr. Marvin Konstam, chief of cardiology at New England Medical Center.
''Frankly, for individuals who are used to a lot of stress, withdrawing from [such a life] can be as stressful, or more stressful, than continuing to do a job that gratifies you and makes you happy,'' he said.
