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GWEN IFILL: To help us understand a little more about the President’s unusual fainting spell, we are joined by Dr. Paul Pepe. He chairs the division of emergency medicine at the University of Texas Southwestern Medical Center. He also serves as an emergency and trauma consultant to the White House medical unit. But tonight he is not speaking for the White House. Dr. Pepe, welcome. How unusual is this episode?
DR. PAUL PEPE: Actually it’s not a common episode but it’s not entirely unusual either. And this is a normal reaction that happens to normal people under certain circumstances. Quite frankly I think the bottom line here is that Barbara Bush is right, you know, chew your food well. In this circumstance from what I best understand is that he swallowed a pretzel and it wasn’t completely chewed. Sometimes if a dry piece of food like that gets stuck in your throat it can be really painful going to your esophagus into your stomachs. As a result it can induce a major painful stimulus that will trigger off the vagus nerve as you said that is a normal nerve that is a break on the heart and can slow things down. Now it goes into overdrive as a reaction to this particular, as we say, nasty stimulus.
GWEN IFILL: This nerve – which goes down both sides — can be triggered by something, the syncope, the fainting that this nerve induced can be triggered by something as simple as choking on a pretzel.
DR. PAUL PEPE: This is a misnomer that he wasn’t really choke inning the classic sense that we think of somebody who has got it in your wind pipe, your airway going down into your lungs. Here he was really swallowing something down your esophagus. In a sense it was something that felt like it was stuck there and it’s extremely painful going down, but it’s unlikely that it caused any serious damage there. But what it does do is it causes a very painful effect that many people will get a reaction. This is like a classic fainting spell that we often hear about — they classically always presented when someone got a bad piece of news in the movies they would have a bad reaction. This again is conducted by the vagus nerve.
GWEN IFILL: From what you can tell and what you’ve heard and read about this episode, was at any point was the President’s life threatened by this?
DR. PAUL PEPE: Not really. You know, in this particular situation again if he had fallen and hit his head against something really, you know, hard and it was a good fall, you know, from a standing position, yeah, it could have been more serious, or if he had literally choked on the pretzel but — or any of the food that was stuck there had regurgitated while he was briefly unconscious there — there about could be a threat there. I know the nurse that was working there yesterday and of course Dr. Tubb, his doctor — they’re both outstanding. He was in really good hands. From everything I understand it was a straightforward situation. And here he had mostly a little bit of a bruised ego as well as a bruised face. But he handled it pretty well I think under the circumstances.
GWEN IFILL: The President is considered to be so healthy and fit that he even has low blood pressure the way we understand it. Could that have made him more susceptible to this kind of fainting episode?
DR. PAUL PEPE: Not necessarily. It’s possible – if someone is used to a lower blood pressure that’s great. It doesn’t make him more susceptible to less blood flow in the brain. It’s all relative to what you have. The vagus nerve is actually active in all of us right now. It’s a normal nerve that actually if you cut it on both sides, you know, for example, a person who gets a heart transplant, they have those cut and their hearts are normally higher without those vagus nerves. The vagus nerves are actually constantly giving what we call vagueal tone. They’re sending down nerve pulses to keep the heart at a steady, low pace. And what happens in a situation like this it gets in brief and I mean brief overdrive that can knock the heart rate down. We actually often use the vagueal nerve for people with fast heart rates – we often use it to stimulate way. There are different ways.
GWEN IFILL: We are almost out of time. I want to ask you two brief things. He had a dental cleaning on Saturday and had a mild cold over the weekend. Could either of those two things have triggered this?
DR. PAUL PEPE: It’s conceivable that there are two things, probably not the dental cleaning as much as the cold, yeah, could make you a little bit more susceptible if there was a slight fever. It all depends. But I think in general this is a normal thing that can happen to normal people. Here it just happened to happen to a normal President.
GWEN IFILL: Thank you very much, Dr. Pepe, for joining us.