What does Senator Bernie Sanders’ hospitalization reveal about his health and his ability to continue his presidential campaign?
His staff has provided scant details: Sanders experienced chest pains at a campaign event Tuesday and went to a hospital. Doctors found blockage in an artery and inserted two tiny metal tubes, called stents, to prop it open. The 78-year-old presidential candidate expects to leave the hospital “before the end of the weekend,” rest for a few days, and resume his campaign in time to participate in the Oct. 15 debate.
The Sanders’ campaign did not respond to the Globe’s request for more information. So we asked three local cardiologists, who are not privy to specifics about Sanders’ condition, to shed light on what the incident may portend based on their experience with other heart patients. Here’s what they said.
Did Sanders have a heart attack?
The campaign has not said whether or not he had a heart attack, which is a sudden blockage of an artery that causes damage to the heart muscle.
Dr. Jeremy Samuel Faust, an emergency physician at Brigham and Women’s Hospital, wrote in a Slate article that Sanders most likely did suffer a heart attack, based on how quickly the staff rushed him in for the procedure.
The cardiologists whom the Globe consulted were more circumspect, saying it’s possible he had a small heart attack, but they can’t tell based on the information revealed so far.
“It sounds like he had some kind of acute coronary syndrome,” in which blood flow to the heart is blocked, said Dr. Malissa J. Wood, a cardiologist at Massachusetts General Hospital. “The great thing is he noticed the symptoms and got help immediately, so they were able to get that artery opened fast.”
Dr. Jeffrey J. Popma, an interventional cardiologist at Beth Israel Deaconess Medical Center, did not see much significance in the team’s decision to swiftly open the blockage. “How quickly it was done doesn’t really mean there was a more urgent or worsened prognosis,” he said.
Does it matter whether it was a heart attack or just a blockage? “Having a small heart attack slightly increases the risk of death or heart attack over the next year. But it’s still low,” Popma said. “Even if there was a big heart attack the prognosis is still very good.”
Wood noted that most of the severe problems from a coronary blockage occur when a person stays home despite their symptoms. The fact that Sanders got immediate attention augurs well for his recovery, she said.
What is the procedure that Sanders underwent?
It’s called coronary angioplasty or percutaneous coronary intervention, and more than a million people have the procedure done each year, Popma said.
Dr. Carey D. Kimmelstiel, director of the Interventional Cardiology Center at Tufts Medical Center, said the procedure — it’s not considered surgery — does not require general anesthesia. The patient receives medications to relieve pain and anxiety, but remains awake throughout, lying on a table in a room called the cardiac catheterization laboratory.
The doctor inserts a slender, flexible plastic tube into a blood vessel, usually entering at the wrist or the groin, and threads the tube, or catheter, into the heart. There she injects a dye that makes the blood vessels visible on an X-ray. This identifies the location of the blockage. The catheter, with a tiny balloon at its tip, is maneuvered into the blockage. The balloon is inflated to open up the artery, and then the mesh stent or stents are put in place to keep the artery open. The stent is coated in medication that prevents blood clots.
Does angioplasty require a long hospitalization?
“For a certain percentage of patients, we do it outpatient and send them home the same day,” Kimmelstiel said. Others may stay overnight.
Over 90 percent go home within a day or two, Popma said.
Still, the cardiologists didn’t see anything ominous in the decision to keep Sanders in the hospital for several days, attributing the longer stay to extreme caution because of this patient’s prominence.
“I would imagine that they just want to make sure he’s perfect when he leaves,” Popma said. “That doesn’t bother me too much that he’s going to stay around for a few days.”
What happens next?
Today, doctors have a toolkit of highly effective medications to treat and prevent blocked arteries. These include drugs to thin the blood, lower blood pressure, and reduce cholesterol levels. The patient is advised to adopt a heart-healthy diet and exercise regularly. Typically patients attend cardiac rehab — supervised exercise sessions — three days a week.
The medications are highly effective in preventing new blockages, and the stents rarely need to be replaced, the doctors said.
What is the prognosis?
That depends on the patient’s condition before the incident, Popma said: “If you’re vigorous when you go in, you’ll be pretty vigorous when you come out.”
It also depends on the patient’s motivation to maintain a healthy lifestyle, Kimmelstiel said. Usually, he said, patients leave in better condition than when they arrived and face few limitations.
“If Sanders didn’t have any previous heart troubles and didn’t have a major heart attack, “I imagine he would be back on the campaign trail in a relatively short time,” Kimmelstiel said.
Sanders’ vigor and motivation appear well documented.
“From all indications, from what we’ve learned about this so far,” Popma said, “he should be in shape to go back on the campaign trail. Over a couple, three weeks, we get patients back to normal activities. After a month, it’s a memory.”