Two Hearts (like Two Americas) Beat As One
Former Senator and Presidential Candiate John Edwards has successfully petitioned Federal Court for a two month delay his case because he states that he has a life-threatening heart condition that will require surgery in a month.
First and foremost, Dr. J. wishes nothing but best wishes and prayers to Mr. Edwards and his family and hopes that whatever his condition is, that it can be treated and he has a speedy recovery.
Now Dr. J. knows a thing or two about the heart, and heart conditions. After all, heart disease (specifically atherosclerotic disease) is the most prevalent illness in the US. If you’re going to be in the medical field, you should be aware of what is common and how to treat it.
So, let us look at the news items revolving around his illness:
A federal judge disclosed Friday that former presidential candidate John Edwards has a life-threatening heart condition, a court source confirmed to CNN.The criminal trial has been delayed until at least March 26, according to the court source… Judge Catherine Eagles said she has been in contact with Edwards’ cardiologist, who recommended a postponement, saying Edwards is scheduled to undergo surgery next month. –CNN
Ex-presidential candidate John Edwards has a serious heart condition that will require a medical procedure next month and his illness limits his travel including for an upcoming court case over possible campaign violations, his doctor told a judge, who delayed the trial.
Federal Judge Catherine Eagles did not disclose the exact nature of Edwards’ illness Friday or what procedure he needed. However, she said the two-time presidential candidate had “three episodes’’ and indicated his condition could be life-threatening if left untreated.
A cardiologist for the 58-year-old ex-North Carolina senator wrote two letters about his condition to Eagles, who talked about them during a hearing to consider whether the trial on six felony and misdemeanor counts should begin this month. Eagles said jury selection will now start March 26, at the earliest.
Edwards is taking medication and is scheduled to undergo a procedure in February from which it will take several days to recover, Eagles said. She did not describe what the episodes involved or if the procedure would require unclogging arteries or other common treatments. The doctor’s letters and other medical records have been kept under seal by the court. –Boston.com
The criminal trial of John Edwards that was set to begin Jan. 30 will be delayed at least two months because the former Democratic presidential candidate has a “real and serious” heart condition that requires medical intervention.
Federal Judge Catherine Eagles granted the delay after noting that she had received two letters from Edwards’ cardiologist detailing the nature of the heart trouble.
While the precise condition was not discussed in open court, it was revealed that Edwards has had three “episodes” in recent weeks and that he is scheduled to undergo a procedure next month. Edwards has also been advised to avoid driving. – ABC News
Ex-presidential candidate John Edwards has a serious health condition that requires treatment and limits on his travel, sources told NBC News on Friday. It had been reported that the judge delayed Edwards’ campaign-finance trial and described Edwards’ condition as life-threatening. But a source told NBC News that the condition is an arrhythmia that might require implantation of a pacemaker. Another source said the judge described Edwards’ condition as serious.
And The Associated Press phrased it this way: Federal Judge Catherine Eagles did not disclose the exact nature of Edwards’ illness Friday or what procedure he needed. However, she said the two-time presidential candidate had “three episodes” and indicated his condition could be life-threatening if left untreated. – MSNBC
OK, Gentle Readers, you get the idea…
What Dr. J. wants to talk to you about is the idea of life-threatening. There is acutely life-threatening, meaning, this needs to be taken care of right now, and conditions that are not acutely life-threatening but need to be addressed soon, before they are life threatening.
To make this easy, Dr. J. will make a list of some life-threatening cardiac conditions, and by life-threatening, he means that if they aren’t treated (at some point) they will very likely shorten your life expectancy…
1) Acute Myocardial Infarction (ST-elevation Myocardial Infarction). This is what Fred Sanford called ‘the big one.’ Mortality from an MI is about 8% despite all of our tricks. The way this normally plays out is that you have stuttering chest pain all day, finally it gets bad enough that you call 911. You get transported to the nearest medical center and they will A) open your artery with a balloon and stent in less than 90 minutes from when you hit the door. B) ship you somewhere near by where they can pull that off, or C) if A and B are impossible, give you a drug (t-PA) to open up that artery, and ship you somewhere than can open you up if the t-PA doesn’t work. In other words, this is an emergency and needs to be addressed now. It is also life threatening in that some die suddenly, like Tim Russert, others die from complications from a big infarct, and your likelihood of dying is much greater if you do nothing.
2) Congestive Heart Failure – The 5 year mortality for individuals with congestive heart failure is pretty high without treatment, but still isn’t great with treatment. For most people, treatment consists of using blood pressure medications as chemotherapy for the heart. For others, a valve replacement, heart transplant, or Ventricular Assist Device prolong life, but life-expectancy is still curtailed. That being said, in most cases, you have years to live, typically, before meeting your maker. Unless you are in cardiogenic shock, this isn’t acutely life-threatening.
3) Aortic Stenosis – This is when your aortic valve is too tight, like Operative Æ. If your valve is too tight, (less than 1 square cm), this isn’t a problem, unless you have symptoms. Then the clock starts ticking. If you develop angina, you have a 50% 5-year mortality, if you have syncope, 50% 3-year, mortality, and if you develop CHF, you have a 50% 2-year mortality. Again, your mortality is measured in (high) percent per year.
4) Obstructive Coronary Disease – This is when you have blockages of > 70% diameter in your coronary arteries. The real risk of death goes to those with a blockage in the left main coronary artery (>50%) or in the 3 main vessels (right, left circumflex and left anterior descending) with weakened pump function. For them bypass surgery prolongs life signficantly. For 3 vessel disease without depressed LV function, their risk is elevated but not that much. For individuals with 1 or 2 vessel disease, their risk of death is greater than those without coronary disease, BUT essentially the same as those with non-obstructive coronary disease. There are other factors, but we aren’t going to get into that. If you need bypass surgery, it doesn’t get kicked down the road.
5) Brady-arrhythmias – This is when the heart goes too slow If you have sick sinus syndrome, symptomatic slow heart beat, Mobitz II 2nd degree atrioventricular block (every other, every third beat makes it from the upper chambers of the heart to the lower chambers of the heart) or 3rd degree atrioventricular block (no beats get from the top to the bottom of the heart) atrioventricular block. This is potentially life threatening and gets dealt with swiftly.
6) Tachy-arrhythmias – Atrial Flutter/Fibrillation has a higher stroke risk, abrogated by blood thinners. Medications can slow rates down. Jolts of electricity can restore regular rhythm. This isn’t truly life threatening (though there is some data saying you are better off if it never happened to you than if it did). Ventricular tachycardia is not good for you, and usually gets shocked. If you are caught having it without a reversible cause, you tend to get a defibrillator.
So from this exhaustive list of conditions that have been quite oversimplified, you can see most truly life-threatening illnesses involving the heart get treated pretty much when identified. There are other conditions where we have some time to work on them but really aren’t that life threatening by most peoples points of view.
Dr. J. suspects that given the latest information from MSNBC, specifically that he has had spells and that it might need a pacemaker, that Mr. Edwards has atrial fibrillation which technically, shortens one life expectancy compared to age matched controls who do not have AFib.
Dr. J. theorizes that he is on blood thinners and tried medicines to maintain rhythm and/or slow his rate and that they failed or he had side effects. Dr. J. would expect that they are going to place a pacemaker and after it has been in place for a couple of weeks and it is clear that it is working fine, that they will do an ‘AV nodal ablation’ to separate the upper and lower chambers of the heart. This will allow his heart rate to be controlled by his pacemaker. Alternatively, they will try an Atrial Fib ablation, where they electrically isolate the pulmonary veins from the rest of the heart, that doesn’t work so great, but can make you feel better for a little while.
Again, Dr. J. wishes Mr. Edwards a speedy recovery from whatever cardiac malady he is currently suffering from, life-threatening, or not.