Lawrence K. Altman, M.D.

WASHINGTON — “None of us know when a medical emergency will affect us,” Sen. Bernie Sanders wrote in a tweet from Desert Springs Hospital Medical Center on Wednesday, hours after the 78-year-old Democratic candidate for president experienced one.

Sanders’ emergency — the sudden onset of chest pain known as angina — is one that thousands of other Americans experience each year. Sanders’ discomfort occurred at a campaign event Tuesday night. Because it signaled acute heart trouble, the senator went to the hospital where doctors implanted two stents in one of the coronary arteries that nourish the heart.

Doctors often release patients who undergo such procedures in a day or two. Sanders remained in the hospital until Friday evening, when — after three days of revealing few details about his condition — his campaign confirmed that Sanders had suffered a heart attack.

Until then, Sanders had not disclosed whether blood and electrocardiogram tests showed he had a heart attack. The senator and his campaign have not allowed reporters to interview his doctors, though advisers have said that Sanders would be able to appear in the next Democratic debate Oct. 15.

With respect to release of health information, President Donald Trump has not had a medical emergency while running for or serving in office, but he disclosed few specific laboratory test results initially in his 2016 campaign. He issued a four-paragraph letter from his personal physician stating that Trump would be “the healthiest individual ever elected to the presidency.” Closer to the 2016 election date, Trump’s doctor offered a more conventional letter that still omitted a number of details that would be part of a customary summary of a patient’s health.

In 2018, the doctor, Harold N. Bornstein, said that Trump aides had raided his office a year earlier and taken the president’s medical files after The New York Times reported that the president had taken a drug for hair growth. And this year, the White House physician pronounced Trump in “very good health” although the president had gained weight and is now officially obese.

The health questions hang over Sanders in part because he would become the nation’s oldest president by far if elected. Also, given that implanting two stents in one coronary artery is a very common procedure in U.S. hospitals, it was puzzling that for several days he did not release more details. Sanders is a private person, no doubt, but most modern-day presidents and serious candidates for the presidency have put forward details to inform the electorate after emergency health issues.

Normally, “recovery from stent placement is very quick,” and patients usually go home a day or two after the procedure, said Dr. Jonathan S. Reiner, a cardiologist at George Washington University Hospital in Washington, D.C., who treated former Vice President Dick Cheney for serious heart disease for many years before, during and after his two terms of office. Reiner is not involved in Sanders’ care.

Older patients and those who experience complications like heart rhythm abnormalities, heart attacks or heart failure may remain in the hospital longer. A patient’s condition usually determines the length of stay.

In the 2016 presidential campaign, Sanders’ doctor said that the senator was “in overall very good health.” His ailments included gout; a mild elevation of cholesterol; an inflammation of out-pouches in the bowel known as diverticulitis; and hormone replacement therapy for an underactive thyroid gland. He had no reported history of heart disease.

Tuesday’s episode of angina appears to be his first such incident.

In cases like Sanders’, doctors perform a standard procedure known as cardiac catheterization. In it, they thread thin tubes into chambers of the heart and inject a radio-opaque dye to produce X-rays outlining the coronary arteries. For Sanders, the procedure revealed blockage in one artery; he has not said which artery. Doctors would then remove the blockage, which is usually caused by deposits of fatty substances, by inflating a tiny balloon in a tube to squash them. Implanting the stents aims at preventing development of scar tissue and recurrence of the blockage.

All presidential hopefuls strive to portray themselves in good health. When a medical event occurs, candidates and their aides, who usually have had little if any medical knowledge, often scurry to play it down to prevent damage to the leader’s image.

Sanders’ event is likely to renew pressure on his rivals to release their health information in a timely fashion. Although some have made pledges, they have not done so.

In recent years, most candidates have released their personal health information in statements from their doctors or through interviews. The practice grew out of retrospective analyses of the health of presidents that document how some presidents hid or lied about their health problems, often aided by their doctors. Occasionally, White House doctors have misdiagnosed a president’s heart and vascular problems.

Experts believe that President Warren Harding died of a heart attack that his doctor did not detect. Toward the end of President Franklin D. Roosevelt’s third term and until his death in his fourth term, his White House doctor withheld the fact that he had serious heart failure. President Dwight D. Eisenhower suffered a heart attack near the end of his first term. Examination of his older medical records has provided strong clues that he had a heart attack before he ran for president.

In 1999, former Sen. Bill Bradley of New Jersey damaged his presidential campaign by not disclosing that he had a number of episodes of atrial fibrillation (a heart rhythm abnormality) before he experienced one while campaigning and had to rush to a hospital in the Bay Area with reporters trailing him.

Among the current candidates, Joe Biden underwent emergency surgery in 1988 for a near-fatal ruptured berry aneurysm of an artery in his brain. He also underwent surgery to remove a second berry aneurysm. New cerebral aneurysms can develop years later in a tiny percentage of individuals who have survived one. In 2008, Biden’s doctor said that he had recovered fully and that he did not need further tests to detect a new berry aneurysm because he had done well for 20 years.

Modern medicine has enabled many individuals with heart disease and other chronic ailments to successfully run for office and fulfill their duties. Nevertheless, Sanders’ stent episode is likely to renew a measure of voter interest in the health of its 2020 presidential candidates. Two other leading Democratic hopefuls are in their 70s, and Trump is 73. All of them, as well as Sanders, may well be medically fit to serve, but Americans have never faced the prospects or consequences of so many top candidates who were past the official retirement age.

This article originally appeared in

Uncommon Reticence After a Common Procedure

(News Analysis)

Doctors often release patients who undergo such procedures in a day or two. Sanders remains in the hospital, and his campaign has closely guarded pertinent details about his heart condition and treatment, raising questions about the extent of his health issues.

Among other things, Sanders has not disclosed whether blood and electrocardiogram tests showed he had a heart attack. The senator and his campaign have not allowed reporters to interview his doctors, though advisers have said that Sanders would be able to appear in the next Democratic debate Oct. 15.

The health questions hang over Sanders in part because he would become the nation’s oldest president by far if elected. Also, given that implanting two stents in one coronary artery is a very common procedure in U.S. hospitals, it is puzzling why he has not released more details. Sanders is a private person, no doubt, but most modern-day presidents and serious candidates for the presidency have put forward details to inform the electorate after emergency health issues.

Tuesday’s episode of angina appears to be his first such incident. Doctors often refer to such heart issues as new onset, or unstable, angina and usually describe an event like Sanders’ as acute coronary syndrome.

Sanders’ status as a presidential candidate may influence his care and possibly lead to his staying in the hospital a bit longer than usual for patients with his ailment. Although doctors say they care for VIPs as they do any other patient, they may deviate from the norm out of caution or if complications occur. A danger in VIP care is a tendency to do too little or too much for a patient.

Bernie Sanders Had a Common Procedure. So Why the Mystery?

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Lawrence K. Altman, M.D.

Articles written by the author

Uncommon Reticence After a Common Procedure

Bernie Sanders Had a Common Procedure. So Why the Mystery?