Cheney's heart needs a jump-start from his doctors
- From: "Jason P" <jaspetr@xxxxxxxxx>
- Date: Tue, 27 Nov 2007 09:19:53 -0800
Cheney's Heartbeat Stable -- for Now
Atrial Fibrillation Poses Little Immediate Risk; Cardiologists Worry About
Implications
By DAN CHILDS
ABC News Medical Unit
Nov. 27, 2007
Cardiologists say Vice President Dick Cheney's episode of irregular heart
rhythm will not likely affect his immediate health - but the condition could
point to a worsening of his continuing heart problems.
Cheney's doctor detected his irregular heartbeat, technically known as
atrial fibrillation, Monday morning when the vice president visited because
of concerns over a lingering cough, believed to be from a cold.
The diagnosis was enough to send Cheney to George Washington University
Hospital for a treatment called cardioversion, which is designed to shock
the heart back into a normal rhythm. The procedure, which took place Monday
afternoon and requires briefly placing the patient under general anesthetic,
"went smoothly and without complication," according to a statement issued by
Cheney's office.
"The Vice President has returned home and will resume his normal schedule
tomorrow at the White House," Monday's statement reads.
Doctors agree that the irregular heartbeat poses little additional threat to
Cheney's health.
"Atrial fibrillation, by itself, is not a very serious heart rhythm
problem," says Dr. Doug Zipes, director emeritus of the cardiology division
of the Indiana University School of Medicine.
Additionally, a cardioversion procedure - should the vice president require
it - will not likely put him in further danger.
"It's a very, very low risk procedure," says Dr. Kim Eagle, clinical
director of the University of Michigan's cardiovascular center. "Almost
always, we are able to effectively restore a patient's heart rhythm to a
normal heart rhythm."
Still, cardiologists say the finding is not good news for Cheney.
"It is something that, if he was my patient, I would wish he didn't have,"
Zipes says. "Individuals with his heart disease history with atrial
fibrillation do not do as well with their condition than those without
atrial fibrillation."
Continuing Heart Troubles
Indeed, the irregular rhythm represents the latest link in a chain of heart
problems for the vice president, a progression that began in 1978 with his
first heart attack, which occurred when Cheney was 37.
Since then, the 66-year-old Cheney has weathered three more heart attacks -
one in 1984, one in 1988, and one in 2000. He underwent quadruple bypass
surgery in 1988, sustained two angioplasties on the blocked artery
responsible for his fourth heart attack, and had an implantable cardioverter
defibrillator, or ICD, installed in 2001, to regulate his heartbeat.
Some worry that this history could mean the vice president's heart troubles
are getting worse.
"Development of atrial fibrillation is generally a negative event," says Dr.
Sanjeev Saksena, director of the Cardiovascular Institute and arrhythmia
service for Atlantic Health, adding that the condition has negative
implications for the ventricles - the two lower chambers of the heart.
"It would imply that his ventrical function deteriorated, and the [atrial
fibrillation] could further worsen it and cause more limitations in his
exercise capacities and ability to function, and can, in turn, provoke
further worsening of heart function," Saksena says.
Despite these concerns, the cardioversion Cheney underwent likely improved
his condition - at least for the time being. Initial success rates for the
procedure are high, with 75 percent to 93 percent of patients experiencing a
normal heart rhythm afterward.
But for many patients, the effects of the treatment are only temporary;
anywhere from one-quarter to one-half of patients relapse within a month of
a successful procedure, and 70 percent to 90 percent experience atrial
fibrillation again within a year.
And the treatment can be an uncomfortable one. Dr. David Haines, chief of
cardiovascular medicine at Beaumont Hospital in Royal Oak, Mich., notes that
the electric shock Cheney received through his chest is "the same shock as a
person in cardiac arrest gets. A person in atrial fibrillation gets it to
restore normal electrical activity."
Treatment Risks and Implications
Cardioversion carries risks of its own, though they are slight. Doctors
likely treated Cheney with anticoagulants before the procedure - if he was
not on them already - to lessen the chances that the procedure would have
dislodged clots, which could have then travel through the bloodstream and
led to stroke. Doctors likely also performed imaging tests of his heart to
ensure that no clots were present.
"We know that individuals with atrial fibrillation are predisposed to clots
and stroke," Zipes says, adding that doctors likely looked to
anticoagulants, such as coumadin, to minimize these risks. The other
potential problem, Zipes notes, is "the fast heart rate associated with
atrial fibrillation.
"This is even more important to patients with defibrillators," he says.
"Shocks can be delivered inappropriately because of the increased heart rate
associated with atrial fibrillation."
Zipes says this increased heart rate is usually treated with drugs intended
to slow the patient's heart rate. But he says that, more important than the
immediate consequences, are the implications with regard to Cheney's overall
heart health.
"The fact that he came in with a lingering cough, apparently from a cold,
certainly could, instead, be a lingering cough from progressive heart
failure," Zipes says.
--
The ABC News Medical Unit
.
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