Bill Clinton's Angioplasty and Stent Procedure
Benjamin C. Wedro, MD, FACEP, FAAEM
Whether the name on the chart is Bill Clinton or John Q. Public, the approach to chest pain in the ER is roughly the same, give or take the presence of a few secret service agents. There are many causes of chest pain, but in a patient like Former President Clinton, who has had previous bypass surgery, heart attack is always a major concern.
With chest pain, the worry is that a heart attack (myocardial infarction) might be in progress. When one of the coronary arteries (blood vessels that supply the heart muscle with oxygen) becomes blocked, muscle begins to die. Time is muscle in terms of potential loss, and the rush begins with the triage nurse or even beforehand if an ambulance is called. If the symptoms suggest the potential for heart attack, treatment guidelines suggest that an electrocardiogram (EKG, ECC) be completed within 10 minutes of arrival at the hospital. A brief look at the EKG allows the doctor to know that the patient is indeed having a heart attack and the blocked blood vessel needs to be reopened. Two options exist, emergency heart catheterization, in which a balloon is used to open up the blockage, or intravenous clot busting medications like TNK or alteplase (TPA). (In the US, less than half of hospitals have emergency heart catheterization capabilities).