- The Washington Times - Tuesday, January 15, 2002

The coughing that caused President Bush to faint for a few moments Sunday triggered a common and benign medical phenomenon, cardiologists say.
“Up to 40 percent of the world population is susceptible to such episodes,” said Dr. Toby Barbey, a cardiologist and professor at Georgetown University Hospital. “From what I know, the president had a vasovagal reaction from choking.”
That means the bit of pretzel that stuck in the president’s throat and the resulting coughing stimulated a nerve called the vagus, which passes through the neck and the area of the chest around the main circulatory and respiratory organs.
The vagus can affect the rate at which blood flows to the heart. In this instance, doctors said, the nerve irritation slowed the president’s blood flow to the point he blacked out and toppled from a sofa in a residential area of the White House.
The type of reaction Mr. Bush experienced can come from other causes, too.
“People can be susceptible to this occasional reaction when they are exceedingly uncomfortable when they are under stress, or frightened or experience some other noxious stimulus. Some people have these episodes when they have blood drawn or stitches removed. President Bush’s father may have had this when he collapsed during a dinner in Japan years ago,” Dr. Barbey said.
The president, however, has a simpler explanation. At the John Deere farm machinery plant in Moline, Ill., yesterday, Mr. Bush told workers who could see the nasty scrape on his cheek that was caused by the fall:
“If my mother is listening: Mother, I should’ve listened to you. ‘Always chew your pretzels before you swallow,’ [she said].
“When I work the rope lines, people bring their children, and I always turn to the child especially the teen-agers and say, ‘Listen. Listen to your mother. It’s the best advice I can give you.’ I obviously needed to do the same thing last night. But I’m feeling great.”
Dr. Patricia Davidson, a cardiologist at the Washington Hospital Center, pointed out that people who have the kind of episode the president experienced commonly are rushed to the hospital.
“What happens then depends on the patient’s history,” Dr. Davidson said. “Almost anyone who experienced such an episode would be given several tests cardiac and neurological evaluations.”
At any rate, the doctors concluded that if there is no other underlying cause for the fainting as the president’s physician declared then there is nothing to worry about.
Added Dr. Barbey, “The president seems able to talk to crowds and to the nation on TV. He seems not to have a stressful nature. So this incident is most likely benign.”

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