Video: Whittington's heart treatment

msnbc.com staff and news service reports
updated 2/14/2006 8:22:40 PM ET 2006-02-15T01:22:40

Despite the heart problem of the man wounded by Vice President Dick Cheney, doctors say removing the shotgun pellet from his chest probably won't be necessary -- and digging it out could do more harm than good.

It's not unusual to live with shrapnel or other foreign objects in the body, even the heart, and specialists said it's likely the pellet will scar over rapidly without causing further problems for Texas lawyer Harry Whittington.

Hospital officials in Corpus Christi announced Tuesday that Whittington had suffered a "minor heart attack" and was returned to the intensive care unit.

It wasn't a traditional heart attack -- no artery was blocked. In fact, the 78-year-old Whittington's doctors called his arteries healthy, and he felt no pain or other symptoms.

What apparently happened: Doctors noticed an irregular heartbeat Tuesday morning and took Whittington in for an exam to see exactly what was going on inside his heart.

One of the pellets from the 28-gauge shotgun that Cheney had fired had migrated to the heart, either touching or embedding into the heart muscle near its top chambers, called the atria. That irritated those chambers to cause the irregular heartbeat known as atrial fibrillation.

But doctors also spotted inflammation -- which always occurs when something foreign invades the body -- that was causing a temporary block in blood flow, by touching or pushing the heart, explained Dr. David Blanchard, chief of emergency care at Christus Spohn Hospital Corpus Christi-Memorial.

That's what he termed a "silent heart attack."

A pellet striking the heart can cause those problems, but it's not normally thought of as a heart attack, said Dr. Samin Sharma, chief of interventional cardiology at New York's Mt. Sinai Medical Center.

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"What probably happened is the pellet hit the heart and the heart released some enzymes" associated with a heart attack, he said. "It usually has a very good prognosis. ... It's not as significant as a heart attack."

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Anti-inflammatory drugs will soothe the inflammation, and the pellet should scar over in time, he said.

Digging it out could cause more damage, specialists agreed.

But Whittington is not out of danger. "If it's migrated to this point it could migrate further," said Dr. Maurizio Miglietta, head of the trauma unit at New York's Bellevue Hospital.

Typically if  a pellet is under the skin and muscle, it’s not able to move very much at all, explained Dr. Scott Monrad, director of Montefiore Medical Center Cardiac Catheterization Laboratory in New York. But because Whittington was shot in the neck and chest, gravity could have carried the pellet down to the heart.

Removal probably would be necessary only if the pellet had penetrated a heart chamber, something Whittington's doctors said didn't happen.

But if there was potential for the pellet to move or cause trouble, Monrad suggested that surgeons might decide to remove the pellet with a special, looped snare device used in a catheterization lab. The removal wouldn’t require open heart surgery, he said.

If they leave it, “it would probably [eventually] be covered with the body’s own cells, the same way that pacemaker wires or stents we put in would be covered,” Monrad said.

As for the atrial fibrillation, it's not immediately dangerous but must be treated because if left uncontrolled, it can spur blood clots. Most cases can be corrected with medication. Hospital officials didn't say Tuesday whether Whittington's heart was beating normally again, or if he was being medicated.

Until Tuesday's complications, physicians had said Whittington had been progressing well after being struck by birdshot in Saturday's hunting incident -- and that they were not concerned about the six to 200 pieces of birdshot that might still be lodged in his body.

Whittington was about 30 yards away from Cheney when shot.

"At this distance he's peppered with lot of small holes," said Dr. J. Wayne Meredith of the Wake Forest School of Medicine, who has seen similar injuries.

A report filed with Texas Parks and Wildlife said the vice president was using size 7 1/2 shot. A three-quarter ounce load of that size shot would normally contain more than 250 pellets. Each pellet is about the size of a small letter "o" in newspaper print.

Birdshot is usually made with steel or lead, but even lead pellets left in the body wouldn't pose a danger of lead poisoning, said Dr. Renae Stafford, a trauma surgeon at the University of North Carolina, Chapel Hill, School of Medicine.

"People speak of lead poisoning, but in reality it's not something we see," agreed Dr. Maurizio A. Miglietta of the New York University School of Medicine.

MSNBC's Jane Weaver, NBC's Robert Bazell and the Associated Press contributed to this report.

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