Former President Bill Clinton, who at age 58 has appeared trim and vigorous, checked into New York Presbyterian Hospital yesterday after suffering chest pains and shortness of breath and was scheduled for quadruple bypass surgery, his office said.
Clinton did not suffer a heart attack, but tests earlier in the day at a suburban hospital found four blockages in his coronary arteries that could trigger an attack if left untreated.
In a statement last night, Sen. Hillary Rodham Clinton said her husband would probably undergo surgery early next week.
"He's in excellent hands, and he's at one of the great hospitals in the world," she said earlier as she cut short a visit to the New York State Fair in Syracuse to join her husband.
The nation's 42nd president, who served from 1993 to 2001, battled his weight for many years and had a well-known fondness for fast food. But he has been on the South Beach low-carbohydrate diet for at least a year and exercises with a personal trainer.
Coronary artery disease claims almost a half-million lives a year in the United States; it is the leading cause of death.
During his presidency, medical tests indicated that his total cholesterol and blood pressure were normal, though his so-called "bad cholesterol" was slightly elevated. Experts noted yesterday that many people develop heart disease whether or not they eat healthy foods, exercise or have risk factors that show up in routine testing.
President Bush extended Clinton "best wishes for a swift and speedy recovery."
Campaigning in Newark, Ohio, Democratic presidential nominee John Kerry told a crowd outside the town hall he was confident Clinton will pull through after surgery.
"I want you all to let a cheer out and a clap that he can hear all the way to New York," he said. "He's going to be fine."
Clinton had made a rousing speech for Kerry at the party's national convention in July and had planned to campaign for him. He also has been on a book-signing tour for his memoir, My Life, and had been scheduled to appear next week in White Marsh.
Experts said Clinton will likely have to avoid strenuous activity for six to eight weeks but could probably make campaign appearances in a few weeks without jeopardizing his health.
Clinton, who had apparently never before experienced symptoms of heart diseases felt discomfort in his chest Thursday, but tests that day at Westchester Medical Center outside New York found nothing wrong.
"We talked through the day and he said he felt fine and not to worry," Hillary Clinton said.
He spent the night at his home in Chappaqua, N.Y., but further testing early yesterday at the suburban hospital prompted doctors to recommend heart surgery. In the test, called an angiogram, doctors inject a dye into the bloodstream and then take a picture of the heart to reveal any blockages.
The test revealed "multivessel coronary artery disease, normal heart function and no heart attack," Dr. Anthony Pucillo, who performed the procedure, told the Associated Press. Pucillo said the blockages were serious enough to warrant an operation.
But heart specialists who were following news of Clinton's illness said the fact that doctors did not rush him into surgery indicated that his life was not immediately in danger.
"That they are postponing the surgery means that he's doing relatively well," said Dr. Luca Vricella, a cardiac surgeon at the Johns Hopkins Hospital in Baltimore.
Vricella said he could infer that the president did not have continuing chest pain or a heart attack. Either one would warrant emergency surgery.
The president had mild chest pain, which occurs when a partial blockage temporarily slows blood flow to the heart.
A heart attack occurs when a blockage halts the supply of blood through one artery. Because this starves the heart muscle of oxygen, it can prove fatal or leave the heart permanently impaired, incapable of pumping blood efficiently.
Barring any complications, bypass operations take up to 4 1/2 hours and require three days to a week of recovery time in the hospital.
In a bypass operation, surgeons usually cut veins from the legs and graft them onto the obstructed coronary arteries. The grafts reroute blood flow around the blockages, restoring normal blood flow.
It was unclear yesterday whether surgeons at Presbyterian Hospital would stop the former president's heart and use a mechanical pump, or operate on a beating heart.
"Beating heart" surgery is often shorter and requires less recovery time, though some surgeons balk at using this technique on patients who have multiple blockages.
In recommending bypass surgery, doctors apparently decided that his condition was too complicated for angioplasty. In that procedure, which does not require splitting the chest or cutting through tissues, doctors snake a catheter to the heart and use it to press the blockages open.
In most cases, doctors then install mesh sleeves called stents to keep the arteries open, although blockages sometimes recur anyway.
Doctors do not ordinarily recommend angioplasty for patients who have four or more blockages, Vricella said, though it is not unheard of.
Dr. Stephen Pollock, a cardiologist at St. Joseph Medical Center in Towson, said there is "no clear-cut dividing line" between angioplasty and bypass. But in general, he said, "If there are too many blockages in too many places, those are people who go ahead and have bypass surgery."
The mortality rate for bypass surgery is less than 3 percent, with some patients dying on the operating table or a short time later from bleeding, stroke, infection or heart attack.
The long-term outlook for patients receiving bypass surgery is good, Pollock said, with many not needing further surgery for a decade or more. About 375,000 bypass operations are done every year in the United States.
"I have any number of patients who were bypassed 20 years ago," said Pollock, who sees patients before and after their operations.
"Long-term, they lead a normal life, but this is a chronic illness," he said. "Heart surgery does not cure heart disease. It is simply a temporary treatment."
The underlying illness can cause blockages to occur elsewhere in the heart or even in the bypass grafts, leading to further pain or a heart attack.
To ensure the best course after surgery, patients are placed on aspirin to thin the blood, cholesterol-lowering medication to prevent further clogging, and a drug to lower blood pressure. Patients are also asked to eat a low-fat diet and to exercise for the rest of their lives.
Though they had no reason to suspect that Clinton was ill, doctors said nobody should be surprised that someone so vigorous had an underlying heart ailment.
The huffing, puffing, overweight stereotype of a person with heart disease is simply wrong, said Pollock, explaining that a third of people with the disease have no symptoms before their first heart attack.
In 1999, White House doctors reported that Clinton had an LDL - or bad cholesterol - level of 134, which is somewhat elevated. But that alone would not trigger great concern or further tests, Pollock said.
Sun staff writers Mark Matthews and Kimberly A.C. Wilson and wire services contributed to this article.
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