Democratic presidential candidate Sen. Bernie Sanders (I-Vt.) speaks during the second night of the first Democratic presidential debate on June 27, 2019, in Miami. (Al Diaz/Miami Herald/TNS)

By Wendy Benjaminson, Michelle Fay Cortez and Sahil Kapur Bloomberg News (TNS)

WASHINGTON — Bernie Sanders and his doctors likely would have known within hours that the Democratic presidential candidate had a heart attack in Las Vegas last Tuesday, cardiologists say, but his campaign described the incident at first as a fleeting episode of chest pain and waited three days to reveal the more serious diagnosis.

The incident has raised questions about the 78-year-old senator’s fitness for the stress of the presidency.

Standard practice when a person comes to a doctor with chest pain is a set of tests that can tell if they are suffering a heart attack, say leading heart doctors including a Harvard medical professor. That rapid diagnosis — which can be performed in minutes — is crucial for doctors to perform frequently lifesaving interventions to open blood flow to the heart muscle.

It took the campaign several days to disclose the severity of the episode. On Oct. 2, a day after the incident, senior adviser Jeff Weaver said Sanders had “experienced some chest discomfort,” and that “following medical evaluation and testing he was found to have a blockage in one artery and two stents were successfully inserted.”

On Oct. 4, the campaign indicated it was something more serious. Sanders said in a tweet that he had been in the hospital for 2 1/2 days. The campaign issued a follow-up statement from treating physicians Arturo E. Marchand and Arjun Gururaj acknowledging it was a heart attack that had required urgent care.

“Sen. Sanders was diagnosed with a myocardial infarction,” the medical term for a heart attack, the doctors said. “He was immediately transferred to Desert Springs Hospital Medical Center.” The doctors said two stents were placed in a blocked coronary artery “in a timely fashion.”

Bloomberg asked the Sanders campaign if he had the blood test to determine whether he had a heart attack on Tuesday per standard procedure. A Sanders campaign aide declined to comment further. Weaver didn’t immediately return a message seeking comment on his Oct. 2 statement.

Sanders, talking to reporters outside his home Tuesday, said he would release his medical records “at the appropriate time.”

The campaign’s differing disclosures last week paint very different medical pictures.

The less serious situation described Tuesday, chest pain, or angina, typically develops when arteries that feed the heart are narrowing so that blood flow is slowing, but not completely blocked. Pain can develop when the heart works harder, such as during exercise. The narrowing of the arteries can be treated with medicine or stents put in electively. Stents are metal inserts threaded into arteries to hold them open.

Far more serious is new or sudden pain, which can signal a heart attack. When that happens, blood flow through the coronary arteries is choked off, depriving the cardiac muscle — the heart itself — of the oxygen-rich blood it needs to keep pumping.

Guidelines from the American College of Cardiology and the American Heart Association state that patients having a classic heart attack should be treated within 90 minutes to open the clogged coronary artery and restore blood flow to the heart. The doctors’ statement Friday that Sanders was “immediately transferred” to a hospital that could clear his arteries speaks to the urgency of his situation.

“I was dumb,” Sanders told reporters outside his home on Tuesday. “I’ve been doing, in some cases, three or four rallies a day, running all over the state, Iowa, New Hampshire, wherever. And yet I in the last month or two just was more fatigued than I usually have been. And I should have listened to those symptoms,” he said.

Sanders skipped a Democratic forum Oct. 4 and 5 sponsored by the Service Employees International Union, one of the largest labor groups in the country and a major force in the Nevada caucuses, the third nominating contest. That allowed his closest progressive rival, Elizabeth Warren, to pitch her labor plan without him doing the same.

“We don’t know what was involved in the current situation,” said Ajay Kirtane, director of the cardiac catheterization laboratories at New York-Presbyterian Hospital and Columbia University Medical Center. “In order to know how he’s going to do, what we need to know is how much damage there actually was. It runs the spectrum of almost minimal to massive. Given these circumstances, it’s likely not massive.”

The health risks following a heart attack aren’t cured by a stent. Older patients already have a higher risk of all types of cardiac problems, said Christopher Cannon, education director of cardiovascular innovation, senior physician at Brigham & Women’s Hospital and professor of medicine at Harvard Medical School

“It would be nice to know” how severe the heart attack was, Cannon said. “The thing for us to know now is how is he going to do in the next five years.”

The campaign’s messaging about his health varied. The statement Wednesday said Sanders was “conversing and in good spirits,” and touting his Medicare for All plan. It also said he would stop campaigning “until further notice,” and the campaign canceled a multimillion dollar ad buy in Iowa.

On Thursday, the campaign announced his first public appearance would be at the Democratic presidential debate in Ohio on Oct. 15 — giving him two weeks off the trail — and the ad time was repurchased.

Sanders has a deep reluctance to make politics about personal matters. He avoids talking about his personal story on the campaign trail. He famously defended 2016 rival Hillary Clinton against questions about her “damn emails.” He refused that year to release his full tax returns; he acquiesced to pressure and disclosed them this spring.

The medical episode highlights Sanders’ status as the oldest of the four septuagenarians who are leading the Democratic field. At 78, Sanders is older than Joe Biden, 76, and Elizabeth Warren, 70. President Donald Trump, who’s running for a second term, is 73.

Presidents undergo annual physicals that are released publicly so that the U.S. public can have confidence in their ability to carry out the stressful job.

Sanders held a call with staff Monday to reassure them of his commitment to the campaign, according to one of his aides.

The aide said Sanders emphasized the importance of “us, not me,” in the campaign, speaking about the “millions of people” working to “bring about the kind of fundamental changes” he believes the country needs.

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(Benjaminson and Kapur reported from Washington, Cortez from Minneapolis.)
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