The Heart of L.BJ.

While Lyndon Johnson was speaking at the L.B.J. Library of the University of Texas at Austin last December, his voice was noticeably weak. At one point he seemed to rub his lips. Then his tone improved, and he finished his speech. What the audience--and later, television viewers--witnessed was a public demonstration of Johnson's severe heart disease and his characteristic determination not to yield to it. "It was almost the greatest pain you ever saw," he said later about the crushing pressure on his chest (angina pectoris). By sleight of hand he had transferred a nitroglycerin tablet from pocket to mouth and slipped it under his tongue. This gave immediate relief from pain.

That heart disease eventually killed

Lyndon Johnson will seem, to many, less surprising than the fact that he survived with it so long. For after a severe heart attack at the age of 46, in mid-1955, Johnson subjected himself to 13 years of the most grueling, tension-ridden work. Yet during that period, his health seemed generally good. Cardiologists reviewing Johnson's medical history see evidence that for him, as for many another cardiac patient, frustration or the slower pace of retirement can be more lethal than the strain of a highly active life.

Change of Style. Before that first heart attack, Johnson abused his body. He smoked two to three packs of cigarettes a day, took little exercise and ate too much fat and sweets. At about 220 Ibs., he was roughly 30 Ibs. overweight. His initial seizure, said Johnson, was "about as bad as a man can have and still live."

The reason he did live, and so fully, was largely because he heeded his physicians. "I think the fact that he stopped smoking was a great thing," says Dr. Campbell Moses, medical director of the American Heart Association. "He changed his lifestyle, and that was a major factor."

Johnson rigidly rationed his alcohol, became a calorie counter and slimmed down to 180 Ibs. That, like giving up smoking, was torture for one raised in Texas ranch country on meals as "filling" (meaning fatty and rich) as Mother could provide, one who had developed a taste for thick, marbled steaks, preferably followed by peaches and cream. Often, when Lady Bird Johnson served dessert to others but none to him, Lyndon tinkled the service bell and demanded his banana pudding.

During the White House years, when Vice Admiral George G. Burkley was his physician, Johnson suffered no angina, the pain that results when the heart muscle protests that it is not getting enough blood. Indeed, Burkley recalls: "If you hadn't known of his previous attack, you would have had a hard time finding anything in his electrocardiogram to indicate it."

There was no excess of cholesterol or other fatty substances in the blood. "We tried to keep him on a low-intake diet," Burkley says, "but he wasn't starved on any strict regimen as a true cardiac patient would be, because he was a normal individual during those years." He got some exercise--swimming, walking, an occasional gym workout--and he usually took an afternoon nap. His blood pressure was normal.

Johnson left the White House in 1969 feeling exhausted and took almost a year to get the weariness out of his bones. Concern about an early death had been one factor in his decision not to seek reelection. He had had his own and his family's medical history (his father died at 60 after a heart attack) fed into a computer, which predicted that he would not live beyond age 64. Johnson told a friend: "I'm going to enjoy the time I've got left. When I go, I want to go quick. I don't want to linger on the way Eisenhower did."

He relaxed about precautions. Late in 1971 he resumed smoking, up to two packs a day. He yielded to his yen for sweets, and his weight went above 200 Ibs, again.

Arteriosclerosis, the accumulation of fatty material inside the coronary arteries, was following its inexorable course. The heart muscle vented its complaint as angina. Because the left ventricle, the main pumping chamber, could not do its work efficiently, it began to enlarge and the body retained fluid--part of the process doctors call congestive heart failure.

Painful Signal. Last April, during a visit to his daughter Lynda Robb in Charlottesville, Va., Johnson had a second, massive heart attack. It left him prey to recurrent angina, relentlessly progressive failure and fear that the next angina attack might signal the end. More than once in subsequent months, after an unusually painful episode, Johnson went to Brooke General Hospital in San Antonio, only to be assured by doctors that he had not suffered yet another attack.

During one of his periodic checkups at the Mayo Clinic in Rochester,

Minn., he was told that the digitalis he was taking regularly, and nitroglycerin "on demand," represented the best that medicine could do for him. After these measures proved to be insufficient, Colonel L.R. Hieger found at the autopsy that of the three main coronary arteries, two were totally blocked, and the third was 60%-80% occluded.

Whether Johnson would have lived longer if he had remained in high office --or had continued to follow doctors' orders--can never be known with certainty. But, says Burkley, "he did better when he was under pressure. I think that it was better for him when he was in harness than when he wasn't. I think his retirement increased the stress. High demands seemed to keep his body at a good metabolic rate."

Several cardiologists agree, though they admit that they have no statistical evidence to support them. Dr. Howard Burchell of Minneapolis, one of the specialists called in as a consultant during L.B.J.'s 1955 heart attack, feels that many people who retire no longer enjoy as good health as when they were active. Of the pressures Johnson experienced in the Senate and White House, Burchell says: "Such stresses, when compensated by rewards and satisfaction, may be no worse than sitting in a rocking chair and fretting." In Texas Lyndon Johnson did not sit and rock, but he must have fretted.

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