What's Behind Whittington's 'Minor Heart Attack'?

The hunting mishap that involved Vice President Dick Cheney took a more serious turn this afternoon. But it won't be clear just how serious until some key questions are answered.

A spokesman for the Corpus Christi hospital that is caring for Harry Whittington, the 78-year old lawyer who was accidentally shot by the Vice President over the weekend, announced that Whittington had suffered "atrial fibrillation" (a particular type of irregular heart rhythm) and a "minor heart attack." Beyond that, few details were immediately available.

Conversations with three physicians, none of whom has any direct information about Mr. Whittington's condition other than what they've read or seen in the press, suggest that the Texas lawyer did not suffer a heart attack in the classic sense most of us think of one—in which a clot blocks the blood flow of an artery. Instead, it appears Whittington suffered some damage—that could easily be temporary—to part of his heart muscle from bird shot, which lodged in or near the heart.

"There are different types of heart attacks, plus nowadays [we can measure] different sizes," says Dr. Robert McNamara, an echocardiographer at Yale University School of Medicine and a spokesman for the American College of Cardiology. Most likely, Dr. McNamara believes, the heart attack was detectable only because of a change in Whittington's EKG or a change in certain enzyme levels in the blood.

In coming days, Whittington's doctors will be monitoring him closely to see if he develops further problems. Because he underwent a cardiac catheterization this morning, which reportedly showed his arteries are in good shape, the greatest concern would be more problems with an irregular heart beat.

All things being equal, atrial fibrillation is a relatively benign condition as long as it can be controlled. Indeed, says Dr. Calvin Weisberger, a regional chief of cardiology for Kaiser Permanente, about 8% to 10% of people over age 80 have a history of atrial fibrillation. Mr. Whittington's atrial fibrillation could be due to his age, the stress of the accident, or the biochemical response of the heart to the pellet.

Doctors at the Corpus Christi hospital will be watching to make sure Mr. Whittington does not develop ventricular fibrillation, a more serious type of irregular heartbeat that can be fatal within minutes. "It will stay a minor problem as long as the arrhythmia stays under control, the heart muscle hasn't suffered permanent damage, he doesn't have a further ongoing heart attack, and there's no fluid building up around the heart," says Dr. Soumi Eachempati, a trauma surgeon at New York Hospital in New York City. Assuming nothing else goes wrong, however, Whittington should be able to go home and resume a normal life.