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Why George W. Bush might have needed a stent

Former president George W. Bush is recovering after he had a procedure to insert a stent to open a blocked artery near his heart.

The problem was discovered during an annual physical examination at the Cooper Clinic in Dallas on Monday, according to a statement. Doctors recommended he have the device put in after they discovered the blockage. The stent was placed this morning without complication.

"President Bush is in high spirits, eager to return home tomorrow and resume his normal schedule on Thursday," a spokesperson said. "He is grateful to the skilled medical professionals who have cared for him. He thanks his family, friends, and fellow citizens for their prayers and well wishes. And he encourages us all to get our regular check-ups."

A stent is a metal mesh device that can prop open a heart's artery to prevent a blockage caused by a buildup of a waxy substance called plaque. Over time, plaque can collect in arteries, which is a condition called atherosclerosis. This narrows the artery, and can potentially cause chest pains -- known as angina -- or a heart attack.

Arteries are smaller than the diameter of a pencil, so the stents are loaded onto a catheter, or tube, about the size of a thin piece of spaghetti, then inserted into the arm or leg and then threaded up the artery. The procedure doesn't require opening up the chest cavity, and the patient is awake the whole time. It usually takes less than an hour, and the patient can go home as soon as the same day or stay overnight for observation.

Dr. Steven Nissen, the department chair of cardiovascular medicine at the Cleveland Clinic, explained to that stents generally are recommended for people having a heart attack or people who have severe symptoms during exercise.

Symptoms can include chest discomfort or heaviness that may radiate into the neck or jaw during exercise or mild exertion, tingling in the left arm, feeling like your heart is racing or profuse sweating, Dr. Mariell L. Jessup, the president of the American Heart Association and a cardiologist at the University of Pennsylvania in Philadelphia, said to Both doctors have no involvement in Bush's case.

"It's a classic thing that we ask is if there is some jaw pain during exercise," Jessup explained, adding that typically patients that have these symptoms are men over 50 and women over 60.

Putting in a stent comes with risks, which is why it is not put in patients who do not have symptoms, Nissen said. People with stents can develop a re-narrowing of their artery or a clot can form in the stent. Patients who have the procedure are required to take blood thinners to prevent the latter problem, he added.

A 2011 JAMA study showed that stents may cause more harm to one out eight patients who get them during emergency procedures, Reuters reported. U.S. doctors put in about 600,000 stents a year.

Patients experiencing chest pains or other symptoms are sometimes diagnosed with a blocked artery through a stress test. But, Nissen pointed out that it would be strange if Bush's blockage was found during a routine stress test during a physical, which is normally not recommended unless the patient is experiencing symptoms.

A stress test involves walking on a treadmill while the patient's heart is monitored with an electrocardiogram, which records the hearts electrical activity over time.

"It often leads to procedures that are not indicated," Nissen explained. "Procedures such as a stent are only useful in people who have symptoms. If you do a stress test in somebody who doesn't have symptoms, it doesn't lead to a benefit."

Jessup added that people shouldn't insist on having a stress test during a routine physical. She recommended discussing any concerns with your doctor during your annual exam, and he or she can determine whether or not you need more exams. Nissen added that routine annual tests like cholesterol and blood pressure checks can often flag problems that warrant further testing.

However, Jessup believes it is possible that the former president receives more extensive routine physical than the average person or that he complained of something that a doctor found concerning enough to warrant more tests.

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