Some of the powerful are weak at heart

Majority Leader Tom Delay (R-Texas) told reporters March 15 that the condition he was hospitalized for two weeks ago is atrial fibrillation (AF), a common type of heart arrhythmia affecting 2.2 million people in the United States. An estimated 10 million Americans have one form or another of heart arrhythmia, which means no more nor less than that their hearts beat irregularly. Vice President Cheney is one of them, former President George H.W. Bush is another, and so is former Sen. Bill Bradley (D-N.J.). Maybe politics is for the weak at heart.

Majority Leader Tom Delay (R-Texas) told reporters March 15 that the condition he was hospitalized for two weeks ago is atrial fibrillation (AF), a common type of heart arrhythmia affecting 2.2 million people in the United States.

An estimated 10 million Americans have one form or another of heart arrhythmia, which means no more nor less than that their hearts beat irregularly. Vice President Cheney is one of them, former President George H.W. Bush is another, and so is former Sen. Bill Bradley (D-N.J.).

Maybe politics is for the weak at heart.

Delay has had AF for five years and occasionally needs an “electric jolt” to get his heart to beat normally again. He was admitted to National Naval Medical Center in Bethesda, Md., after complaining of fatigue on March 10.

The timing was eye-catching, for the Majority Leader had endured intensified attacks by the Democrats and a barrage of bad press during the preceding three weeks.

Allegations of ethical misconduct had been aimed his way because of an all-expense-paid trip to Britain in 2000 courtesy of an Indian tribe and a gambling service, and because of a 2001 trip to South Korea paid for by a foreign agent.

Did stress caused by these allegations contribute to DeLay’s palpitations?

“It’s not stress,” he said after his hospitalization, adding (presumably in jest) that he had no stress in his life.

Was that just the bravado of a tough politician determined to show no sign of weakness?

Dr. Pendleton Alexander, chief of cardiac surgery at George Washington University, said Delay’s condition can be worsened by stress: “The body’s hormones that are part of the stress response may promote the development of AF. There is a presumed connection.”

Delay’s condition, if properly monitored and treated, does not prevent an active life, but most sufferers take blood-thinning medications and are therefore advised not to engage in sports in which they are likely to get cut. Politics is said to be a contact sport, but only figuratively, not literally.

Dr. Ramin Oskoui, a Washington cardiologist, said, “You probably shouldn’t be playing hockey or skiing. You are at no risk standing. … You are at no risk arguing.”

Unless someone punches you in the nose.

There are many different types of heart arrhythmias and as many causes. British Prime Minister Tony Blair suffered from supraventricular tachycardia; a condition that causes sudden bursts of rapid heartbeats — up to 200 beats a minute — originating in the upper chambers of the heart. In October, Blair underwent a procedure called catheter ablation, which involves cauterizing the part of the heart muscle generating the arrhythmia.

Cheney, who has suffered four heart attacks, has an implanted defibrillator that helps resuscitate his heart if an arrhythmia occurs.

AF is often caused by problems in the thyroid gland. That is how Bush senior and Bradley developed AF, although there is no evidence of a direct link AF and defeat by members of the Clinton-Gore ticket.

Most people who have irregular heartbeats do not have to change drastically their lifestyles. “AF is a nuisance,” Oskoui said, “if you don’t drink and you take your medication.”

Patients are urged to avoid caffeine and smoking. It could not be established by press time what fate if any had befallen DeLay’s in-office humidor.

During AF, the upper heart chambers, or atria, can quiver as fast 300-400 beats per minute, speeding the heart itself up to well over 100 beats per minute. Absent any strenuous physical activity, the average adult heart beats 60-80 times each minute.
One way doctors diagnose a heart arrhythmia is with a Holter monitor, a portable electrocardiogram device that makes a 24-hour recording of the heartbeat. When the patient feels an irregular heartbeat, he or she pushes of a button on a sort of pager. At the end of 24 hours, the results are analyzed to see at what point during the day the button was pushed.

Many doctors prescribe beta blockers, calcium-channel blockers or digoxin to treat heart arrhythmias. The drugs attempt stabilize the heart rate by blocking the response to the electrical impulses to the ventricle from the atria and prevent the serious complication of a stroke through blood thinning.

A new method called “the maze” is being used more and more. The cardiologist connects channels within the heart through a small incision to restore a proper rhythm.

“The procedure keeps the electric cycles from developing and allows the correct impulse to be channeled through the ventricle,” Alexander said.

Without treatment, heart arrhythmias can become life threatening. When the heart beats irregularly, the heart fails to pump effectively and blood pools inside the heart. A clot can form inside the atria, break loose and pass through the blood stream into the brain causing a stroke. According to the American Heart Association (AHA), 15 to 20 percent of all strokes occur in people with AF. Sometimes, arrhythmias can lead to congestive heart failure if left unchecked.

AF and other heart arrhythmias can be caused by congenital defects in the aorta, high blood pressure, an overactive thyroid or open-heart surgery. Those most at risk of developing an arrhythmia include older adults, those with lung problems such as asthma or emphysema, those who consume alcohol excessively, smokers and people who use stimulants such as caffeine, according to the AHA. Oskoui said that in 40 percent of cases the cause of the condition is unknown.

There is no way of preventing a heart arrhythmia even if a person lives a “heart healthy” lifestyle, Oskoui said. “This is not a plumbing issue. … It is an electrical problem.”

That does not mean patients should go straight for the bacon and doughnuts in the Longworth Cafeteria. The AHA encourages those who suffer from such conditions to exercise regularly and eat heart-healthy foods to prevent any complications.

Oskoui added that while the life expectancy of a person with a heart arrhythmia is about two or three years less than people who do not have the condition, most patients live full and active lives.