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February 16, 2006

Impact of Shotgun Blast the Likely Trigger for Heart Symptoms in Cheney Victim

Topics: Medicine

svVICTIM_wideweb__470x408,0.jpgBlows to the chest such as steering wheel impact injuries or, in this case, a shotgun injury can cause temporary increases in heart enzymes, which can mimic heart attack, similar to the effects of stress and extreme duress, which can also cause temporary changes in heart rhythm. So the "minor heart attack" reportedly suffered by the hunting companion shot by Vice President Dick Cheney may simply be a reaction to the trauma caused by absorbing a chest full of bird shot at 30 yards.

(...) Deepak L. Bhatt, M.D., director of the interventional cardiology fellowship at the Cleveland Clinic, said that blunt trauma such as that caused by a steering wheel or a baseball thudding into the chest can set up a shock wave that will cause an increase in cardiac enzymes. This, he said, "is one way that a minor heart attack would be diagnosed."

(...) Deepak L. Bhatt, M.D., director of the interventional cardiology fellowship at the Cleveland Clinic, said that blunt trauma such as that caused by a steering wheel or a baseball thudding into the chest can set up a shock wave that will cause an increase in cardiac enzymes. This, he said, "is one way that a minor heart attack would be diagnosed."

(...) In an interview, Dr. Bhatt said that without the opportunity to review the patient's record, it is difficult to explain exactly what happened to Harry M. Whittington, 78, the lawyer who was shot by Cheney during a quail hunt over the weekend.

(...) But Dr. Bhatt said that according to news reports, Whittington had a cardiac catheterization that revealed coronaries that were clear and free of atherosclerotic disease, which is the common cause of ischemic attacks. If those reports are correct, Dr. Bhatt said, a logical explanation for the event is a release of cardiac enzymes in response to trauma..

As for the reports of atrial fibrillation caused by an injury to the atria, either from the trauma itself or from injury caused by the birdshot pellet:

(...) Dr. Bhatt said that temporal disturbances in heart rhythm can be caused by an injury to the atria, either from the trauma itself or from injury caused by the birdshot pellet, which is reportedly lodged near Whittington's heart.

(...) Fred AbiSamra, M.D., director of the electrophysiology lab at the Ochsner Clinic in New Orleans, agreed with Dr. Bhatt's assessment. He noted that although blunt trauma can trigger a release of enzymes and can also cause a temporal disturbance such as atrial fibrillation, "it is does not really carry any significance for the future unless it was a very large traumatic injury."

(...) Another factor that can trigger transient atrial fibrillation, said Dr. AbiSamra, is shock or fear caused by getting shot. "If a patient is under extreme duress, we usually say that they will get a pass on that [atrial fibrillation]."

(...) Both Drs. Bhatt and AbiSamra said it would not be unusual to leave a bird shot pellet or even a bullet lodged in the heart. "These objects normally become very nicely encapsulated and don't cause any additional problems," said Dr. AbiSamra. "We call these chronic bullet wounds. Fishing them out can cause more problems than leaving them in place."

Prognosis wise, Whittingtons looks good, and doctors are confident that the pellet will not any further than its current position. Read more...

Posted by Richard at February 16, 2006 5:33 PM



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