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. Last Updated: 07/27/2016

Yeltsin's Heart: A Mystery Wrapped in Silence

Boris Yeltsin has heart disease. That much -- and very little else -- is certain about the health of the 65-year-old president of Russia.


Yeltsin's physical condition has been the subject of news reports, rumor and scandal. His five years as president have been punctuated by episodes of illness, peculiar behavior and unexplained retreat from public view. And the announcement last week that Yeltsin is running for re-election has revived speculation about his fitness for the job.


Although Yeltsin has experienced two episodes of heart trouble in less than a year, the Kremlin has gone to great lengths to hide details of his illnesses, leading to speculation that his condition is worse than has been announced.


Official reports say Yeltsin suffers from coronary artery disease, the most common heart ailment -- and most common cause of death -- in both Russia and the United States. Almost certainly, he has had one heart attack, and possibly two.


As best as can be determined, he has not undergone angiography, the key diagnostic procedure that most Americans and many Europeans with his medical history would receive. Nor has he had bypass surgery, a treatment for severe coronary artery disease that is performed about 485,000 times a year in the United States and less frequently in Russia.


But the questions about Yeltsin's health overshadow the facts. Among the more important unanswered questions are these: Why has treatment of Yeltsin's coronary artery disease not been more "aggressive," assuming that is the correct diagnosis? Has the president turned down procedures and treatments his physicians favor? Has politics or concern for his image affected medical decisions?


What explains the sporadic facial "puffiness'' mentioned in news reports? Is Yeltsin sometimes unsteady on his feet? If he is, what is the cause?


Does he have pain from a back injury he suffered in 1990 that was operated on in 1993? Does he take painkillers that may have a sedative effect? What medications does he use regularly?


Only Yeltsin or his doctors can answer these questions pains'' and added, "I had suffered a physical breakdown.''


On July 11, 1995, Yeltsin was admitted to Moscow's Central Clinical Hospital with chest pain specifically attributed to problems with his heart. Official pronouncements included two important words: "ischemia'' and "angina.'' Neither ischemia nor angina, however, is a medical diagnosis. Instead, they are terms describing the results and symptoms of a disease.


Ischemia is a deficiency of blood flow to a living tissue or organ. Many things can cause ischemia. Pinching, cutting or plugging an artery can each cause ischemia by robbing the tissue served by the artery of oxygen-rich blood.


Angina is short for angina pectoris, the term for chest pain that arises from insufficient blood flow to the heart muscle.


The blood vessels in question are called coronary arteries, which deliver blood to the heart muscle. (They are not the vessels that carry blood into and out of the heart's pumping chambers.) Ischemia in the three coronary arteries is usually caused by the accumulation of cholesterol, calcium and excess cells on the vessel's inner walls, a process called atherosclerosis. Prolonged or severe ischemia can lead to death of the heart muscle served by the narrowed artery. That is called a myocardial infarction, or, in more common parlance, a heart attack.


Several days after Yeltsin's July hospitalization, a medical official announced the president had suffered a "surface myocardial infarction'' -- one that does not extend through the entire heart wall. These are less damaging than full-thickness infarctions, and often leave a patient with a normal electrocardiogram, or EKG. According to his press secretary, Yeltsin's EKG was normal.


Yeltsin spent two weeks in the hospital and another two weeks at a government resort.


On Oct. 26, he was flown by helicopter from his country residence to a Moscow hospital, again suffering chest pain. This bout was more serious than the earlier one, according to several reports.


Officials again named "acute ischemia." Vorobyov, the physician, appeared on Russian public television and said Yeltsin's EKG "showed little change'' from his previous ones -- which suggests he had not had a myocardial infarction.


But some observers are skeptical. Mikhail Alshibai, a cardiologist at the Institute of Cardiosurgery in Moscow, was asked in a recent interview with New Times magazine if Yeltsin had suffered a heart attack in October. He replied: "It is possible. We know very little about it, only that it was much worse than his first one. And it took a great deal longer to treat it."


Yeltsin stayed out of public view for a longer period this time. Many reports said he received "active therapy,'' but details of that treatment were not specified.


Several reports suggest his treatment has emphasized non-pharmacological interventions. Yeltsin is on a low-salt diet and his spokesman said he lost about 22 pounds by mid-December. He reportedly also has quit drinking, though excessive alcohol intake is not a major factor causing atherosclerotic coronary disease.


It appears, however, that he has not undergone angiography, a procedure in which the coronary arteries are momentarily filled with an opaque dye and X-rays are taken. This process outlines the inner contours of the vessels, revealing the location and size of blockages. If coronary artery bypass surgery is contemplated, angiography must be performed.


Leo Bockeria, a distinguished Russian heart surgeon and chairman of Moscow's Bakulev Institute for Cardiac Surgery, said in a recent interview that although he was not consulted in Yeltsin's case, he was certain that angiography was not done.


"The people taking care of him are the best cardiologists in our country. I am sure they do not see the necessity," he said.