President George W. Bush wore a medical device for "persons at risk of cardiac arrest" during the debates. It is a LifeVest defibrillator. He started using it sometime after his January 2002 fall at the White House. He said he choked on a pretzel. The pretzel stuck in his throat and caused the vagus nerve to send a signal to his heart. This slowed it down and reduced blood flow so much he passed out, said White House physician Col. Richard J. Tubb, M.D. Bush's heart doctor is Kenneth Cooper, a friend from Dallas, who runs the Cooper Clinic.


Based on photos showing him wearing the device, we can conclude the fainting was caused by atrial fibrillation, which his father also had. His father's AF was caused by Graves' disease (a thyroid disease), which Barbara Bush also has. Bush Jr. probably has AF and, less probably, Graves', based on his family history and symptoms. The AF may have caused a stroke or TIA (mini-stroke). Physicians watching the debates detected symptoms of this. Observers have noted psychological symptoms of this and of Wernicke-Korsakoff disease.


When the monitor detects a dangerous heart condition, it sends a signal to a small box on Bush's belt that can cause the defibrillator to send an electrical pulse to the large "shocking electrode" on the Bush's back between his shoulder blades (visible in photos of the president in the second and third debates, and thought by some to be a radio interface with Karl Rove) and a smaller one on the chest. The pulse can be repeated until the heart starts pumping blood effectively, up to five pulses. The electrode on the back can not be made small. There is no radio or bullet-resistant vest that looks like the LifeVest electrode.


In the January 2002 pretzel choking, President Bush said the faint was brief -- a few seconds. When fainting begins and ends suddenly, the cause of fainting usually is not what his doctors reported, "vaso-vagal syncope" but instead is a heart rhythm problem such as atrial fibrillation (AF). Chronic AF is why with Mr. Bush needs constant monitoring and fast defibrillation. Ventricular fibrillation quickly causes death. The LifeVest the president wears stops ventricular fibrillation or ventricular tachycardia (heart beats too fast) to prevent sudden cardiac death. This may be the reason the president wore the device during the debates, though he risked exposing his weakness, especially if the device alarm sounded.


President Bush's father had the same problem. Running at Camp David on a Saturday afternoon (May 4, 1991), Bush Sr. got short of breath, tight chest, and a general feeling of fatigue. A White House physician discovered Bush had an irregular heartbeat, later diagnosed as atrial fibrillation caused by Graves' disease, a form of overactive thyroid.


Has Bush had a stroke? The evidence of a stroke or TIA (transient ischemic attack) is less strong. There are symptoms, as we see on TV appearances and in news reports.


After watching the third presidential debate, Dr. W. Kendall Tongier, an anesthesiologist for 15 years, posted on the Dallas Morning News website a note about his concerns that the president may have had a stroke. His post said:


"As a physician and a professor, I tend to pick up on signs and symptoms of physical problems better than most other people. I am highly concerned with what I saw. The drooping left side of the president's face, his mouth and nasolabial fold (the crease in the face running from the nostril to the side of mouth) may be indicative of a recent stroke, TIA or, possibly, Botox injections.


But I'd like to see the Bush campaign at least give an explanation."


There was no explanation, and the president delayed his annual medical examination until after the election. "The president remains in superb physical condition," said Adam M. Robinson Jr., commander of the National Naval Medical Center in Bethesda, Md., after the president's fourth annual physical at the center on Dec. 11. These days, Bush has substituted bicycling for running. He injured himself last July after a fall off his mountain bike while racing down a trail at his Crawford, Texas, ranch.


So here is the president strapped into his shock harness. At the same time, there are reports that Vice President Cheney has swollen feet, a sign of congestive heart failure. The Washington Post reported that he recently had to increase his show size to 10EEE -- the widest one can get in a shoe store.

==================================================