Understanding Zardari’s Heart Trouble:


 
President Asif Ali Zardari had a “cardiac episode” on Tuesday and was flown to Dubai the same evening for a check-up, according to a government source. Some of the medicines “did not agree” with Zardari but the president’s prognosis is good, says our source.
 
Zardari is known to have coronary artery disease, blockages in the arteries of his heart. During his stay in the U.S., before his return to Pakistan in end-2007, it was well known in Pakistani-American physician circles that he had an angioplasty and stenting procedure performed to open one of his blocked arteries.
 
Earlier this year, Zardari had angiography done in the U.K. to determine whether his stents were open and working properly. There were some rumors that another blocked artery was discovered and another stent was placed to keep it open. However, he received a clean bill of health at that time and has been quite well since then. Zardari has three stents in his heart.
 
There were media reports on Tuesday afternoon that Zardari had undergone an emergency check-up at the Armed Forces Institute of Cardiology in Rawalpindi. His spokesman Farhatullah Babar denied the reports. There were then reports that he was transferred to Dubai in an “air ambulance.” This was also denied, and the official word is that Zardari is in Dubai to see his daughters and undergo a routine, preplanned check-up.
 
There are some recent reports that Zardari is also suffering from some impairment of facial expressions. A Foreign Policy piece quotes an unnamed former U.S. official as claiming that Zardari was “incoherent” when U.S. President Barack Obama spoke to him over the weekend.
 
Putting these different reports together with his previously known heart problems, it is likely that Zardari has either developed a blockage of the previously placed stents in his heart arteries or developed a new blockage that could have caused heart damage and will require further treatment.
 
As far as the “facial impairment” and the reported incoherence are concerned, these can be explained by some bleeding into the brain. This is a known complication in people who have had previous stents since they require heavy doses of special blood-thinning medicines to keep the stents open and working. Any blood-thinning medicine can as a side effect increase the chances of bleeding in any part of the body, including the brain. However, such bleeding is often limited and stops once the medicines are discontinued.
 
The blockages in the heart arteries or in the previous stents can be treated by further stent placement, but if there has indeed been any bleeding complication from the blood-thinning medicines then the procedure can be much more complicated. Perhaps it is for this reason that Dr. Fayaz Shawl, a senior cardiologist from Maryland, is reportedly in Dubai to take care of Zardari’s cardiac problems.
 
Hussain is a cardiac surgeon and editor-at-large of Newsweek Pakistan.
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