Whittington was probably shot IN THE HEART
Wed Feb 15, 2006 at 08:06:05 AM PDT
okay, let's take the gloves off. America is probably being sold a bill of goods on the Whittington shooting and heart attack, and I am now referring to the medical aspects. Whittington has a flattened pellet in his right coronary artery. How did it get there?
You are getting some mumbo-jumbo from the landowner/hospital about how he just got some pellets "sprayed" into his skin ("like little raindrops"), and one "moved" into a vein, then just "flowed" down into his heart. Great. Seems almost like it isn't Cheney's fault, doesn't it?
Except it makes no sense. What makes sense, and what has been previously reported in similar cases, is that one of the pellets was shot directly into his heart.
MORE
Let's start with the propagandoid story.
Like every thinking doctor in America, I am scratching my head over the "wandering birdshot" confabulation. Venous blood (from the skin) can't get to the coronary arteries except by going though the heart, to the lungs, and back through the heart, out the aorta, and then into the coronary arteries. In this postulated journey, the shot would have gotten stuck in the lungs, unless the man has one of a couple of weird medical conditions that this healthy 78-year old man does not have. And this is a chunk of lead, mind you, not some bit of blood clot. It is heavy. And it is relatively big, and it doesn't squeeze down to get around corners.
No, people, that sucker didn't get into the coronary artery by wandering from skin into a vein into the heart, imho,
it was shot there.
There are two reported cases similar to Whittington's. Here is one. From the Texas Heart Institute:
Tex Heart Inst J. 2003; 30(2): 158-160. Copyright © 2003 by the Texas Heart® Institute, Houston
Gunshot Injury of the Heart An Unusual Cause of Acute Myocardial Infarction
Harinder K. Bali, DM, Rajesh Vijayvergiya, DM, Sunip Banarjee, DM, and Nikhil Kumar, DM.
In May 1998, a 30-year-old man was brought to the emergency room with multiple pellet injuries in the chest and face after being shot. At the time of admission, he did not mention any chest pain that would have
suggested myocardial infarction.... The cardiovascular examination showed nothing unusual. During his pre-anesthetic examination for an eye injury, performed 48 hours after the accident, an electrocardiogram showed changes indicating an acute inferior-wall myocardial infarction. Chest radiography showed multiple pellets in the chest, including one in the cardiac silhouette... There was no pericardial effusion. A computed
tomographic scan of the chest confirmed the presence of an intracardiac foreign body.... Elective coronary angiography showed complete occlusion of the distal right coronary artery (RCA) by a 2x2-mm pellet embedded in the heart. The pellet was moving in accordance with the RCA
motion. There was a thrombus in the RCA proximal to the occlusion. The distal RCA was filling through collateral vessels from the left coronary artery (Fig. 4). A left ventriculogram showed inferior-wall hypokinesia [infarction implied] The patient was managed conservatively with aspirin, 150 mg per day, and metoprolol, 50 mg, twice a day. At the 6-month
follow-up, he was asymptomatic and underwent an uneventful treadmill stress test. He remained asymptomatic when last seen in May 2002.
The clinical presentation of a penetrating cardiac injury depends on several factors, such as the type of object, size of the wound, structures damaged, the presence of pericardial tamponade, and associated
noncardiac injuries. Our patient had total occlusion of the distal RCA by a shotgun pellet, which caused an uncomplicated inferior-wall myocardial infarction. He was successfully managed with conservative medical
treatment. ...Despite the fact that a pellet had become embedded in the heart and was occluding the RCA, our patient had an uneventful recovery.
Only 1 similar case has been reported in the world medical literature; that patient also had an uneventful recovery after RCA occlusion by a shotgun pellet.
I hope this isn't too technical. Basically, the pellet got into the heart by being shot there....look at the impact pattern: over the chest (some reports say right, others say left); one of the pellets came out of the gun and blew
through the chest wall and into the heart, where it directly or indirectly caused occlusion of the coronary artery and caused the infarct.
Okay, I don't know for sure what happened to Whittington, and I don't want to sound like Bill Frist. But this scenario only makes sense. You wait, some thoracic surgeon or ER doc will come up with the same story tomorrow. But you heard it here first. I'm betting it will come out that Whittington was shot in the heart.
UPDATE: See
this article showing that other MDs feel the same way.
Dr. O. Wayne Isom, the chairman of heart and chest surgery at Weill Cornell Medical College, said it was unlikely that a pellet would migrate to the heart through the bloodstream, as some have assumed from the account of the Texas doctors.
The reason, Dr. Isom said, is that the pellet would have to enter a vein, travel to and through the lung vessels that go to the heart, and then lodge in heart tissue, not in one of its chambers. The pellets were approximately five millimeters, about the size of a BB, and larger than most blood vessels, said Dr. David Blanchard, director of emergency services at the hospital.
A more likely explanation, Dr. Isom said, is that the pellet lodged in or touched the heart when Mr. Whittington was shot.
