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Diagnosing Musharraf

by Syed Mansoor Hussain
Aamir Qureshi—AFP

Aamir Qureshi—AFP

A heart surgeon weighs in on Musharraf’s ticker trouble.

[dropcap]P[/dropcap]ervez Musharraf remains hospitalized at the Armed Forces Institute of Cardiology in Rawalpindi. Pakistan’s former president and Army chief has been there since Jan. 2, when he developed heart trouble en route to a special court that is to indict him for the treason of sacking some 60 judges in November 2007. Musharraf’s detour set off a news storm—with contentious political, legal, moral, and ethical issues being furiously debated—that has yet to subside.

Did Musharraf require hospitalization? According to news reports, Musharraf had to be rushed to AFIC after he developed a severe and persistent chest pain that traveled to his arm, began to sweat and feel sick. Such complaints in a 70-year-old are extremely suggestive of serious heart problems and a possible heart attack. If this description of how he felt is correct, immediate hospitalization was the right call.

In classical medical terminology, such complaints were referred to as “unstable angina pectoris” but are now included in the spectrum of “acute coronary syndrome.” At AFIC, Musharraf was admitted to a coronary-care unit and received medications to stabilize his condition. Basic tests were then done. We do not have any details of these initial tests, but we do know that these excluded the possibility of an actual acute myocardial infarction or heart attack.

Subsequent diagnostic tests were also performed. Again, we do not have any details of what tests were done, but based on the reports submitted to the court, one thing is clear: besides having general problems that many people his age have, the important finding was that he has considerable calcium deposits in the arteries of his heart.

It would seem that the one important heart test Musharraf did go through at AFIC was a CT angiogram. This is primarily an advanced x-ray that besides providing a picture of the heart arteries also yields an assessment of the amount of calcium deposited in them. The higher the calcium score, the greater are the chances of having severe blockages of the arteries.

Many of us remember that during one of his visits to the U.S., then-president Musharraf made a mysterious side trip to middle-of-nowhere Paris, Texas, where Pakistani-American cardiologist Dr. Arjumand Hashmi runs a sophisticated cardiac center. It is possible but not confirmed that at that time Musharraf at least underwent a CT angiogram. When Dr. Hashmi now states that Musharraf has serious blockages in his heart arteries, he is probably comparing the calcium scoring done at his facility many years ago with the latest AFIC results.

Based on what is known, it would appear that Musharraf does indeed have considerable blockages of his heart arteries. The extent of these blockages is, however, being debated by people who don’t know the difference between a heart artery and a vein in the heart.

The latest question being raised by these armchair heart specialists is the question of an angiography. They claim Musharraf has refused to have an angiography. As someone who has seen thousands of angiography test results over my professional lifetime, and operated on a few thousand patients based on these results, I am entirely amused by this sudden expertise developed by media personalities and lawyers who have no idea what this test is all about.

Coronary angiography is a specialized test that requires the passage of a catheter or small plastic tube through the artery in the leg or the arm into a heart artery so that a special medicine can be injected and x-ray pictures can be taken to outline artery blockages. This is an invasive procedure. And like all invasive procedures it can only be performed if the patient agrees to go through with it. Medical ethics hold that it is entirely Musharraf’s right to refuse such a procedure. (Frankly, looking at the chief prosecutor in this case, my suggestion to Musharraf as a heart doctor would be to have a coronary angiogram done as soon as possible.)

AFIC is a pretty good place to take care of the problem of heart artery blockages. But, again, it is the patient’s sole right whether he wishes to seek further care from Ajmer Sharif or Paris, Texas. If a Pakistani court or a government official denies a patient that right and there happens to be an unfortunate outcome, will that court or government official then responsible be willing to accept the charge of being accessory to homicide?

Many pundits and politicians are of the opinion that Musharraf is lying, that he was never sick and sought refuge at the Army-run AFIC to avoid indictment. As far as the lying part goes, even the interior minister Chaudhry Nisar Ali Khan has said that Musharraf’s health scare was genuine. Musharraf’s choice to opt for an Army hospital appears fairly obvious and far from sensational: as a former soldier, he obviously felt more comfortable being treated in an Army facility. After Pakistan Tehreek-e-Insaf chief Imran Khan fell off a forklift last year and required hospitalization for spine fractures, he ended up not in an orthopedic hospital but at his own hospital—a cancer hospital. This was because Khan was sure he would get the best possible care there. Patients prefer hospitals where they know the doctors involved and can expect good care, so it is entirely appropriate that Musharraf went to an Army hospital.

There is also a lot of reactive nonsense about Musharraf’s wanting to seek treatment abroad when there is “quality” medical care available in the country. Both Prime Minister Nawaz Sharif and Punjab Chief Minister Shahbaz Sharif are known to visit London every so often for “routine” medical checkups. Since politicians don’t want people to know they are sick, there’s been no disclosure about the medical details of these checkups. And, of course, we all remember when Asif Ali Zardari as president developed neurological problems thought to be heart trouble and ended up in Dubai for diagnosis and treatment. There’s also the security issue. The chances of successful treatment and survival of Patient Musharraf, Al Qaeda and the Taliban’s most-wanted man, are far brighter abroad.

Hussain is a cardiac surgeon and editor-at-large of Newsweek Pakistan. From our Feb. 8, 2014, issue.

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Mir Asim January 27, 2014 - 2:50 pm

A very Well written article…

Raza January 27, 2014 - 2:57 pm


Moazzam Salim January 27, 2014 - 3:36 pm

Maybe Musharraf is sick. Maybe he needs angiography. And a patient has a right to have his treatment anywhere he wants. But, what if the patient is the sole accused in a High Treason case? And just as the good Doctor is allergic to being dictated by lawyers, I being a lawyer am highly allergic to being dictated by doctors trying to be a lawyer! The truth is that medical facilities to the accused under arrest are granted by the State. No doubt best medical services should be provided but that can only happen with the jurisdiction of the prosecuting authority; in this case a special Court. No where in the world an accused under arrest is provided this dream treatment where the accused can choose the venue of his treatment anywhere in the world. There is a lesson to be learned here; Lawyers should not try to become doctors and the doctors should not reciprocate!

ehsan January 27, 2014 - 5:40 pm

he may be accused but not under arrest

Taj Khan January 27, 2014 - 7:00 pm

This is a congroo court, already had decided that Mushraf had committed the crime before the trial. What kind of justice is this? Singling out one man, you currupt people, where is justice in Pakistan? Criminals get free for money. He is accused but not arrested dear and might get arrested before the trial. Shame on this justice.

aussie January 28, 2014 - 8:14 am

Patient’s right come before any other right .. This is practiced all over the world .. Unfortunately the lawyers and courts are based to the hilt to accept that

Rana January 27, 2014 - 4:27 pm

Unlike Musharraf, Zardari, Nawaz and Shahbaz are not evading a treason trial indictment. While a free man has all rights to decide where he wants to be treated an accused in treason trial does. If Musharraf is allowed this right then all other criminals should be allowed to proceed abroad if they want medical treatment there to evade punishment

aussie January 28, 2014 - 8:17 am

He is a free man .. He is not indigted nor is he under arrest .. and nawaz asked for permission to go to England for hair transplant when he was in Saudi. . And zardari gave medical certificate of dementia to avoid courts

Dr. Shamim Ahmad January 27, 2014 - 7:05 pm

Unfortunately we have very short memory, Nusrat Bhutto was under arrest when she was allowed to go abroad for the treatment of her so called throat cancer, she lived many years after that, even Asif Zardari enjoyed treatment at Newyork hospitals while a prisoner. Musharraf is still a free man and it his right to choose the hospital/doctors of his choice.

Mir Masood January 27, 2014 - 7:37 pm

I thought good doctors do not diagnose based on opinions. I am shocked to see the authority enforced in the conclusions while admitting the he knows nothing about the conditions or reports. :)

Xeric January 27, 2014 - 8:22 pm

If they such doubts, why not just get a second opinion on him? Medical reports of any individual are supposed to be confidential, however our ‘great’ media proudly displayed his reports online, one even uploaded it to scribd. Now, as the reoports are available, why not just seek opinion from some other renowned cardio sepcialist FORMALLY (not the way media have been doing by asking evety Tommy, Dicky and Hamesh during news hours).

Safdar January 27, 2014 - 9:44 pm

How about we invite specialist in Pk to treat him. Musharraf is a chronic liar and his attitude towards courts doesnot earn him any sympathies.

jamila January 27, 2014 - 10:36 pm

The special court and judges are chosen and appointed by a partisan Prime Minister and Chief Justice who have personal grudges; the CJ has himself dismissed judges. One of the judges is not even qualified for the post! In fact an expert says that even Musharraf’s team of lawyers do not have to attend the sessions of this illegally chosen kangaroo court! The prosecutor says that he has taken on the case so that in the future there will be no dictator in this democracy; his emoluments are a pittance. How come he flew with 100 kilos free baggage against all rules?
Firstly, Musharraf was in a plane mid-air when the army stepped in to save the plane from crashing with the COAS and almost 100 school children, Is that treason or treachery or permitted by the law of the land?
Secondly, Musharraf did not contravene the ‘abeyance’ stipulation which was not even a clause or section of Article 6, when the supposedly enormous crime was committed. According to the Constitution the sanctity and security of a country is more important than the Constitution. Pray of what use is a Constitution if the country’s administration is paralyzed by the CJ’s interference and is within days of being declared a ‘failed; state?

Mehriene January 28, 2014 - 12:45 am

Musharraf is taking the coward’s way out ! If he has a serious heart problem ,he should waste no time in getting the proper treatment ASAP. Pakistani doctors and hospitals are as good as any abroad ,especially the AFIC ! He just wants to run away with his tail between his legs ………..

Zia January 28, 2014 - 7:56 am

Musharraf has neither been charged nor been arrested, he is a free man and has every right to get treatment where he chooses, not where lawyers want him treated. But I can understand the frustration of some lawyers (not all) in Pakistan because they wanted Musharraf convicted within 10 days without due process. Now the due process is in the Supreme Court, not in the special court that was constituted for only the purpose of handing down a conviction.

aussie January 28, 2014 - 8:11 am

The medical records of a patient are confidential. . Even if the court ordered them to be presented, the court has breached the confidentiality of those results by making them public .. but in Pakistan who can dare to challenge a kangaroo court

Hassan Tariq January 28, 2014 - 6:41 pm

In my view, there is no need to discuss and no right to disclose someone’s health issues like this. This is the problem with Pakistanis. They just can’t stop talking about other people (a sign of shallow people). Doctors should spend their energy on other more pressing health matters in the country. Very unfortunate.

Dr. Ehsan January 28, 2014 - 11:57 pm

The lawyers are becoming cardiologists and giving opinions.In his case ETT not recommended and enzyme test is normal if there is no MI(myocardial infarction) In his case there is narrowing of arteries due to calcium deposit. During any procedure this can dislodge resulting in massive infarction which may be fatal.Musharraf has every right to chose his doctor and hospital .Akram Sheikh should take admission in medical college.

khalidmurad1 January 29, 2014 - 1:37 am

It is a very fine article, written with logic. In fact all educated and genuinely patriot people are absolutely and whole heartedly with Musharraf.
Musharraf gave 40 years of Exemplary Services to Pakistan in Army uniform. He booted Indian Army (five times larger in size) at Kargil. Enemy General VK Singh openly appreciated Musharraf’s courage to have stayed with his troops 15 miles inside Indian territory and accused own Indian Army, for not taking any actions. Here are these classical pests.
(1) The PM hijacked the plan carrying General Musharraf, serving Chief of Pakistan Army and forced it to land in India, thus handing over his serving Army Chief to Indians.
(2) So called intellectual claiming Musharraf, liable to be hanged for his atrocities on the killers of Pakistani people including, soldiers, women and children. These pseudo intellectuals are professing the sale purchase of youth being used as suicide bombers and their use for blowing up other innocents.
(3) The PM and the PCO CJ have framed “High Treason Case” against Musharraf.
In1958 Pundit Nehru had rightly predicted that Drama of Pakistan wouldn’t last for more than six months henceforth. That was another dictator Ayub Khan, who did dirty Ghaddari like Musharraf, which gave 65 years of more life to Pakistan.
A nation who’s Army Chief is declared “Ghaddar” after 40 years of Army service and commanding the whole Army, just answere my questions below:-
(1) Are we not the most “Beghairat” and “Manhoos” nation on God’s earth?
(2) Haven’t they rightly stamped us “The Most Corrupt Nation of the World”?
(3) Do we really have the right to exist on God’s earth?

ijaz ahmad January 29, 2014 - 12:33 pm

Surprizingly, Pakistan appears to be the only country in the world where everybody sitting in talkshows offers his expert opinion on Musharaf’s cardiac report, whether he is educated or not.What a pity.

Dr.Ehsan January 29, 2014 - 8:58 pm

There are about 1.5 million of his fans(facebook) who are under stress are getting heart attack daily you can imagine the person 70 years old going on I wonder how he did not get earlier !.

Maqsood Hussain Qureshi January 31, 2014 - 7:28 am

Musharraf should be allowed treatment at his choice of hospital.Courts and judges have prejudice / grudge against him. It is against norms of ethics. It clearly seems they are bent upon giving him severe punishment come what may.

dr.ehsan February 1, 2014 - 3:16 am

The congroo court dismisses the medical report and issues arrest warent how they will arrest him from his bed all lawyers giving opinion on talk shows today. Everybody has a right to save his life from wolves any way he chooses.

Sartaj Hussain March 7, 2014 - 6:44 pm

the constitution of 1973 of Pakistan remained under the 8th.amendment in 1985 and the clause 58-2B till the 18th. amendment ,this clause gave all authority to the then General Zia ul haq who occupied the presidency through a fake reffrendum in 1985 and this clause empowered him to dissolve the assembly and government ,the on duty general superceeded the constitution and this power later used by three presidents one handed over power in 1993 to Benazir Bhutto and Ghulam Ishaq Khan appointed and dissolved the teo prime ministers Benazir Bhutto and Nawaz Sharif and again Farooq Ahemd Khan Laghari used this power and dismissed Benazir’s Govt. and later a COAS General Waheed Kakar removed president and prime Minister both though he was not enjoying the post of president but the Power of an Army General finished both elected President and Prime Minister too. so the power vested into the uniform of an Army general which remain with General Perwaiz Musharaf through an order of SC of Pakistan that made his action to remove Nawaz shrif Prime Minister From his post and also SC allowed him to amend the constitution and later allowed him to contest presidential electons in 2007 in the uniform the case againt the emergency plus of 3rd.Nov.2077 is ridiculous because Gen. Musharaf again enjoying the validty to be the presic dent in Uniform by the SC for presidential elections 2007 what ambiguity in this act of 3rd. Nov. 2007 a Person in presidency enjoying the powers through 59-2B and later by SC. And again in 2007 by SC . nothing is for the case against RTD. Perwaiz Musharaf.


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