While campaigning in Las Vegas on Tuesday of last week, Vermont Senator Bernie Sanders began experiencing tightness in his chest. He was rushed to a hospital where he was diagnosed with a heart attack and had two stents implanted to open blocked arteries.
Little to nothing beyond these bare details of his health condition is known but, as Politico put it, this event has “cast a cloud over his candidacy.”
Is it appropriate for voters to lose confidence in Sanders at this point? He was already the oldest candidate in the race at age 78 years. Would he survive a 4 year term in the grueling position of head of the free world?
An American Federation of Aging white paper, Longevity and Health of U.S. Presidential Candidates for the 2020 Election, used data from national vital statistics to estimate lifespan, healthspan (years of healthy living), disabled lifespan, and four- and eight-year survival probabilities for U.S. citizens with attributes matching those of the 27 then candidates for Presidency.
Its conclusions:
Given the favorable health and longevity trajectories of almost all of the presidential candidates relative to the average member of the same age and gender group in the U.S., and the apparent current good health of all of the candidates, there is reason to question whether age should be used at all in making judgments about prospective presidential candidates
I would agree that individual health is more important than chronological age in evaluating longevity and in Sanders’ case the heart attack may be an indicator of a poor prognosis and an inability to withstand the rigors of campaigning for and serving as president.
Unfortunately we need to know a lot more about Sanders’ heart attack and overall health to make this determination.
Big Heart Attack Or Little Heart Attack?
A heart attack or myocardial infarction (MI) occurs when heart muscle does not get enough blood/oxygen to keep the myocardial cells alive. This typically is due to a tight blockage in one of the coronary arteries supplying blood to the heart, thus constricting the blood flow to a segment of heart muscle (myocardium).
The size of Sanders’ heart attack is an important determinant of his prognosis. The more myocardial cells that died the larger the damage. We can detect and quantify heart attacks with a blood test using a cardiac specific protein called troponin.
Some heart attacks are tiny and only detected by very slight increases in the troponin in the blood whereas larger ones result in large increases in the troponin. What kind did Sanders have?
The more damage to the main pumping chamber of the heart, the left ventricle, the weaker the pumping action as measured by the ejection fraction. The lower the ejection fraction the more likely the development of heart failure. What is Sanders ejection fraction? Does he have any evidence of heart failure?
Stunned or Hibernating Myocardium?
With some heart attacks the heart muscle doesn’t die but becomes stunned-weakened but still living. Under other circumstances a tightly blocked coronary artery doesn’t cause a heart attack but the reduced oxygen supply causes the muscle to stop working-in effect hibernating. Thus, 3 months from now Sanders’ heart muscle function may improve as these stunned or hibernating myocardial cells come back to full function. What will Sanders’ ejection fraction be 3 months from now.? Will he have evidence of heart failure at that time?
Troponin levels and EF are just two of many factors that will determine Sanders’ prognosis.
A recent review of such factors on the one year post MI prognosis concluded
Secular trends showed a consistent decrease in mortality and morbidity after acute MI from early to more recent study periods. The relative risk for all-cause death and cardiovascular outcomes (recurrent MI, cardiovascular death) was at least 30% higher than that in a general reference population at both 1–3 years and 3–5 years after MI. Risk factors leading to worse outcomes after MI included comorbid diabetes, hypertension and peripheral artery disease, older age, reduced renal function, and history of stroke.
Hopefully, prior to the Iowa caucases all the candidates will release their medical records for the public to review. Only by learning more details about Senator Sanders’ heart attack and his overall medical condition can we answer whether he is fit to serve as President. Similarly, heretofore unknown individual health conditions could markedly effect the prognosis of any of the other candidates and their medical records should be equally scrutinized.
Skeptically Yours,
-ACP
9 thoughts on “Is Bernie Sanders Fit To Be President After His Heart Attack?”
Do cardiomyocytes ever regenerate? I was under the impression that after birth cardiomyocytes are no longer able to proliferate and are replaced by fibrous scar tissue in the event of MI or loss of oxygen to the myocardium. Is that correct? If that is correct does EF go down because the new tissue that replaces necrotic myocardial tissue in LV lose its syncytium with existing cardiomyocytes as well as losing its elastic capabilities like typical myocardial tissue. I assume that why the LAD is the widow maker because it supplies oxygen/nutrients to LV myocardium.
They don’t regenerate and are replaced by scar tissue. The scar tissue doesn’t contract so doesn’t contribute to pumping function.
LAD commonly termed widowmaker because it usually supplies the largest section of muscle in the left ventricle
2 physiological age estimators that have recently been developed are the VO2 MAX estimator developed from the HUNT 3 study and the A-BEST calculator of the Cleveland Clinic. I prefer the HUNT 3 estimator because you don’t need to do an actual treadmill tolerance test. The HUNT 3 calculator has been validated and is reliable. The same algorithm is used in PAI based Fitness calculators. PAI, in my opinion, is a very good way to check your own CV fitness on a weekly basis. If you obtain 100 on the PAI then you are doing enough Cardio to significantly reduce the risk of heart disease. I achieve 100 PAI after only 25 minutes of working out on the incline treadmill at a 30% gradient and an average speed of 3.6 mph. Let me caution that if you walk or run on a flat surface you will have to spend a lot more time to achieve a PAI of 100. For anyone who wants to know more just Google Personal Activity Intelligence a validated way to significantly reduce the risk of CVD.
I would think that cardiac rehab would be very very beneficial for senator Sanders. Hope he does it and i wish him the very best.
I think you made a very important point. I also believe we need to consider a candidate’s health as to whether they can take the stressful job of being president.
Sincerely appreciate your posts. Regarding post acute MI risks, among other factors, the referenced study lists comorbid hypertension
Probably this is a dumb question but is a person who is successfully monitoring and maintaining their BP at healthy levels using lifestyle and medication still considered hypertensive and therefore at greater risk?
Again, thank you for helping us non-medical types become more informed. As someone who is now in my third year post-NSTEMI your posts have done a lot to set my mind (and that of my spouse!) at ease.
Steve,
Not a dumb question at all. If you look at the MESA risk estimator app “history of hypertension” is a risk factor even if you enter in a normal systolic blood pressure. You could look at how your risk changes based on whether you count yourself as having a history of hypertension or not to get an idea of what risk it implies.
Obviously though we think that controlling BP substantially reduces that excess risk.
Considering the current trend of things political, it seems we should know more about Pence’s health . . . perhaps even Pelosi’s!
How much access do we have? How much ought we to have – to these all too human figures so close to the presidency?
Too bad the current guy won’t release his full records. Fair play is not his strong point. We do know he gained 4 pounds and is now categorically obese. Big macs and fish filets on the menu.He’s teflon though, so what does it matter? Incredible.
I wrote about one thing we do know about Trump’s heart….https://theskepticalcardiologist.com/2018/01/18/donald-trump-has-moderate-coronary-plaque-this-is-normal-for-his-age-and-we-already-knew-it/