After Fetterman’s stroke, doctors review Senate campaign prospects

What’s really the prognosis for John Fetterman, the Democratic Senate candidate from Pennsylvania who suffered a stroke on May 13?

The 52-year-old Pennsylvania lieutenant governor won his party’s nomination days later, setting up one of the most important Senate contests of the midterm elections. But pressing medical questions remain.

He was discharged from hospital, his campaign said on Sunday, and Mr Fetterman said doctors had assured him he would make a full recovery – but the campaign did not say when he will be able to resume campaigning.

“I’m going to take the time I need now to rest and get to 100% so I can go full throttle soon and flip that seat blue,” Fetterman said in a statement on Sunday, adding that he felt “good” but destined to “continue to rest and recover”.

With such a big race hanging in the balance, which could decide a majority in the Senate, Mr. Fetterman’s medical condition is of intense public interest. Yet despite repeated requests, his campaign has not made him or his doctors available to discuss his stroke and medical treatment.

And experts in stroke, heart disease and electrophysiology have said some of the campaign’s public statements do not offer a sufficient explanation for the diagnosis Mr. Fetterman described or the treatment they say they received.

The stroke, he said in a statement released by his campaign, was caused by a blood clot. He said the clot was the result of atrial fibrillation, a condition in which the upper chambers of the heart beat chaotically and are out of sync with the lower chambers of the heart. The campaign said the clot was successfully removed by doctors at a nearby community hospital, Lancaster General Hospital.

On May 17, the day of the primary election, Mr. Fetterman had a pacemaker and defibrillator implanted in his heart which, according to his press office in a statement, “will help protect his heart and treat the cause. underlying cause of his stroke, atrial fibrillation (A-fib), by regulating his heart rate and rhythm.His press office said he is expected to fully recover from his stroke.

Specialist doctors asked about Mr. Fetterman’s treatment with a defibrillator. They say it would only make sense if he had another condition that put him at risk of sudden death, such as cardiomyopathy – weakened heart muscle. Such heart disease may have caused the blood clot. Or, doctors say the campaign might be correct about atrial fibrillation causing the clot.

Thrombectomy, the method likely used to remove the clot, also indicates that Mr Fetterman suffered more than a minor stroke, although prompt treatment may have prevented damage and saved his brain.

“I stayed in the hospital for over a week,” Mr. Fetterman said in a statement. “I am aware that this is serious and I take my recovery seriously.”

In a brief interview on May 20, Gisele Barreto Fetterman, Mr. Fetterman’s wife, told the story of his stroke, from her perspective.

“We had campaigned on the road,” she said. “We had breakfast and he felt good.”

The couple got into a car to go to an event at Millersville University when, she said, “the left side of his mouth went down for a second.”

“I had a gut feeling that something was going on,” Ms Fetterman said. “I yelled at the soldier, ‘I think he has a stroke.’ He said, ‘I’m fine. What are you talking about? I feel good.'”

The state trooper quickly drove Mr Fetterman to Lancaster General Hospital where his treatment began. Ms Fetterman said it involved going through the groin, suggesting he underwent a thrombectomy, a procedure in which doctors slip a small plastic tube into the groin, advance it into the brain and then remove the blood clot using a suction or wire mesh. .

It was only two days later that his campaign announced that Mr Fetterman had been hospitalized with a stroke. Asked about the delay, Ms Fetterman said: ‘Less than 48 hours is a pretty impressive delay when it comes to sensitive medical issues.

Shortly after that question, Rebecca Katz, a senior campaign adviser to Mr. Fetterman, abruptly ended the call with Ms. Fetterman.

Medical specialists said some aspects of the story were difficult to reconcile with their knowledge of stroke treatment.

Dr. Lee Schwamm, a stroke specialist at Massachusetts General Hospital and professor of neurology at Harvard Medical School, said doctors only perform a thrombectomy when a large artery in the brain is blocked.

“You usually wouldn’t do it for someone with just a little bit of facial sag,” he said. Dr. Schwamm wondered if the doctors who examined Mr. Fetterman at the hospital had noticed any other symptoms, such as loss of vision on his left side or lack of consciousness on his left side, often referred to as “neglect.” “.

“These strokes tend to be very severe,” Dr. Schwamm said. “He’s lucky he went to a hospital that could treat him.”

Pressed on the stroke symptoms as described by Ms. Fetterman, a spokesperson for Mr. Fetterman wrote in an email that he “told The Associated Press last week that Gisele” noticed that John wasn’t himself, and soon after, he started blurring his speech. ‘”

But what caused the stroke?

Ms Fetterman said her husband knew he had atrial fibrillation, which puts him at high risk of stroke, and had taken blood thinners, a standard method of reducing stroke risk in people with atrial fibrillation, “from time to time”.

But treatment with a pacemaker and defibrillator is a headache if he only had atrial fibrillation, medical specialists said.

“It doesn’t quite make sense,” said Dr. Brahmajee Nallamothu, an interventional cardiologist at the University of Michigan.

Dr. Elaine Wan, associate professor of medicine in cardiology and cardiac electrophysiology at Columbia University Medical Center, said defibrillators — which are always accompanied by pacemakers — are used to prevent sudden death. They are usually implanted in people with weakened heart muscle, or in those who have survived an episode in which the heart stopped, or in people with a genetic predisposition to sudden cardiac death.

“We wouldn’t use it for atrial fibrillation,” Dr. Wan said.

Dr. Rajat Deo, associate professor of medicine and cardiac electrophysiologist at the University of Pennsylvania’s Perelman School of Medicine, agreed with the use of defibrillators and said he shared Dr. Wan’s suspicions that Mr. Fetterman had a damaged heart.

“I think it would be fair to say he has at least two separate issues,” Dr. Deo said of Mr. Fetterman. “One is atrial fibrillation, from which he most likely suffered a stroke which was successfully treated.”

He added: “The second issue is that he likely has an underlying heart condition which increases his risk of ventricular arrhythmia and therefore sudden cardiac death.”

Atrial fibrillation could be linked to the other condition, Dr. Deo said. Patients with weakened heart muscle are also at risk of developing atrial fibrillation.

On the other hand, says Dr. Deo, Mr. Fetterman’s atrial fibrillation may have nothing to do with his weakened heart. Without more information from his doctors, it is impossible to know.

Dr. Deo added that if Mr. Fetterman receives appropriate advanced medical therapies and is protected by a defibrillator from sudden cardiac death, “he should do just fine as he continues his campaign.”

Experts have also raised concerns about the prospects of former Vice President Dick Cheney, who had a defibrillator implanted in 2001. He completed two terms in the White House, including a hard-fought re-election in 2004 .

And there’s still time before the general election campaign in Pennsylvania begins in earnest: It’s unclear who Mr. Fetterman’s opponent will be, as the Republican race remains too close to be called and could be heading for a recount.

But Dr. Wan was less optimistic than Dr. Deo about Mr. Fetterman.

“He is at risk of sudden cardiac death,” she said. “For someone on the campaign trail who might raise concerns.”

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