Wednesday, October 15, 2008

Cheney Has Afib Again

Just heard Vice President Dick Cheney had another arrhythmia - seems his atrial fibrillation has kicked in again. Since he's probably already on warfarin for his deep venous throboses, if he ate breakfast, they might administer Ibutilide to pharmachologically cardiovert him, or if he was without food for a sufficient period of time, consider cardioversion.


Addendum 1300 CST - From "Later this afternoon, the vice president will visit George Washington University Hospital for an outpatient procedure to restore his normal rhythm." Translation: He'll go to the hospital four hours after his last meal, be sedated, then have his defibrillator shock him back to normal rhythm, be monitored briefly, then return to the Vice Presidential mansion.


Christian Sinclair said...

"Four hours after his last meal" I had to double take when I read that.

I thought I had missed a major news event!

Anonymous said...

in patients with atrial fibrillation and an icd, do you prefer to use the icd to shock them versus external cardioversion?

The Happy Hospitalist said...

Another day, another shock. I wonder how big his left atrium is. I also wonder how often he gets his INR checked. Maybe they have some kind of super secret implantable INR reader with real time measurements. I wonder how much his hospital collected in fees for this little endeavor, and how that compares with Medicare payment rates.

Anonymous said...

Dr. Wes, I've been reading for some time as I came across your site looking for some cardiac info for my 37 year Hubby - that's for another topic! I have a few related off topic question to this current post. If you wouldn't mind me asking! Mother in Law had a angiogram within the last 4 weeks, which came up with no blockages, she had this procedures because the Thallium Stress test was not the best results. My question - My MIL has had two angiograms in the last 4 years - the stress tests that precluded the angiograms showed signs of blockage in different areas of the heart, however the anigograms have not - why is that? Why would the thallium show blockages when there wasn't any? Isn't there some sort of danger of having so many angiogram? The MIL has congenital heart disease wherein the old ticker skips a beat, she is convinced she is dying with every step and whenever she lies down because she can feel the beats skipping. She also refuses to exercise because of this CHD, even though we are trying to convince that it would actually benefit her. Oh Vey!

DrWes said...

anony 10:29 -

I often prefer to use the previously-installed defibrillator to shock them back to normal rhythm: it's usually effective, requires no external patches, and leaves no potential for chest irritation post-shock. If the shock is ineffective, the external pads can still be used if needed. However, in patients who need their defibrillator often for arrhythmia management with shocks, I'll usually use the external shocking pads to conserve battery life of the installed device.


The situation you describe about your mother-in-law (MIL) is a common consequence of many of our tests in cardiology: false positives. That is, a test that come back "positive" for disease when none is present.

False positive thallium tests are common, usually with attenuation artifact from the stomach and diaphragm causing a "cold spot" on the inferior wall during imaging due to differences in the radiation count being detected by the camera overlying the heart. Breast attentuation in women is also common and might be another cause for false positives. Finally, patient's with left bundle branch block (an EKG abnormality) can have false positive results in the septal area when the thallium is coupled with an acceleration of heart rate (as in exercise or dobutamine stress tests) - adenosine thalliums are less suseptible to this artifact.

Although I do not know your MIL, once a positive thallium is discovered, doctors are left to explain the positive test. They may choose to proceed with angiography for diagnostic reasons if the suspicion is high enough to warrant the test. Certainly angiography is invasive, and has complications, but the risk of ignoring these findings might also have consequences.

Hope that helps.

Anonymous said...

Helps a ton, thanks Dr. Wes... finally an explanation I can understand...sort of!! : )