ROBERT SIEGEL, host:
We thought we'd all benefit from some more medical knowledge about the situation that we've heard reported for Mr. Whittington, and joining us now by telephone is Dr. Stuart Seides, who is a cardiologist and associate director of cardiology at the Washington Hospital Center. Welcome back to the program, Dr. Seides.
Dr. STUART F. SEIDES (Associate director of cardiology, Washington Hospital Center): Thank you.
SIEGEL: What we heard first from the hospital is that Mr. Whittington has had a minor heart attack caused by a pellet, an irregularity in the heartbeat caused by a pellet. How serious is that?
Dr. SEIDES: Well, much like yourself, what I know is what I have heard from the media, and obviously I've not had an opportunity to review his medical records. My understanding is that there was a pellet that migrated and touched off a rhythm disturbance due to irritation because of its proximity to the heart, and then the notion of a heart attack. An arrhythmia or rhythm disturbance does not always cause a heart attack, but a heart attack is generally defined by some damage to the heart muscle, and that was presumably detected by some release of enzymes or proteins in the blood stream. The doctor seemed to be emphasizing that it's a minor attack, which would mean that the amount of damage was small.
SIEGEL: The chief of emergency care at the hospital in Corpus Christi called it, and I quote, "a silent heart attack, an asymptomatic heart attack." He's not had a heart attack in the traditional sense.
Dr. SEIDES: Well, you know, heart attack is a lay term, and by its nature imprecise. I think he meant, when he used the word silent, that Mr. Whittington did not have any of the traditional signs and symptoms of a person having a heart attack, and those would include the typical squeezing, chest discomfort under the breastbone, and so forth. But of course Mr. Whittington was shot in the chest, so he might not notice that type of discomfort as distinct.
SIEGEL: If there is a very small piece of this birdshot, to use the words of the hospital director, lodged into part of the man's heart, is that something that one can leave there? I mean, is it, I've heard about people who have had bullets and other tissue in their body for a long time, it would just stay there. Do you leave it there, or do you have to go in, do you think, and operate and extract it?
Dr. SEIDES: Not necessarily. You know, again, birdshot is very, very tiny, and it would be conceivable that it would remain stationary and then become encapsulated. You know, the body is very clever when it senses a foreign body and tends to wall it off and encapsulate it. Whether or not it needs to be removed is a clinical question that will be determined as the days go on. You know, one thing that one would have to remember is that finding the thing would not be that easy, I don't believe. You know, we're talking about something that is very small, and while it may be easy to see on an X-ray, it might not be that easy to find, and of course you'd have to do an open chest exploration, which would be a fair undertaking in a man of 78 years.
SIEGEL: The hospital administrator said that Mr. Whittington will probably stay in the hospital for another week so that they can make sure that shot doesn't move to other organs or to another part of his body. What's the organ that you would be most concerned about right now?
Dr. SEIDES: Well, again, you know, I have not seen his X-rays, nor do I know what the pattern of the scattershot is. But I presume that what they would be looking for is for the shot that is in there to be stable, not move, be walled off, not erode into the cavity or chambers of the heart, where it could do a great deal of damage. In other words, if the shot made its way into the bloodstream, it could then potentially travel with the bloodstream and create a great deal of mischief. And so I think what they're talking about is having it be stable. And then once it's stable for a period of time, again, the body will tend to wall it off and it will tend not to migrate any further.
SIEGEL: So there could be a full recovery from this, without a major heart operation, conceivably.
Dr. SEIDES: Conceivably, I think that could be the case.
SIEGEL: Dr. Seides, thanks a lot for talking with us once again.
Dr. SEIDES: A pleasure, as always.
SIEGEL: Stuart Seides, who is a cardiologist and associate director of cardiology at the Washington Hospital Center. Transcript provided by NPR, Copyright NPR.
