Man Shot By Vice President Back in Intensive Care

JEFFREY BROWN:

The announcement about 78-year-old Harry Whittington's medical condition came this afternoon at Christus Spohn Hospital in Corpus Christi. The Austin lawyer and Republican fundraiser was accidentally shot Saturday by Vice President Cheney during a quail hunting trip in south Texas.

PETER BANKO, Administrator, Christus Spohn Hospital:

Mr. Whittington has a very healthy heart – as I said yesterday, probably healthier than mine — however some of the bird shot appears to have moved and lodged into a part of his heart causing the atrial fib and what we would say is a minor heart attack.

At this point in time there's no plans to do surgery to remove that bird shot. It's fixed in the heart at this point in time; however, it will require that we monitor Mr. Whittington for up to another seven days in the hospital to make sure no more bird shot moves into vital organs as well as that piece of bird shot doesn't move anywhere else in the heart.

DR. DAVID BLANCHARD:

When you take the initial injury from bird shot, it does break the skin to enter. The first forty-eight to seventy-two hours are usually the most critical because until the inflammatory response occurs and the pellets become seeded — not pellets, bird shot become seeded, we don't know exactly what will happen down the line if the will shift position. 99.99 percent are not problematic at all but it's one problematic bird shot in this particular case that we feel has caused the entire problem and that's what we're monitoring very carefully.

The beebee basically has lodged in a certain areas causing inflammatory changes. When that occurs, there's irritability to the heart muscle because the heart muscle and it recognizes that there's a foreign body there and, as a result, the chambers of the heart, the two top chambers, not the bottom, were beating irregularly. It is basically like an electrical short circuit called atrial fibrillation; it is easy treated with medications. It's a non-surgical type of a condition.

REPORTER:

What about a chance of infection from this beebee?

DR. DAVID BLANCHARD:

Well, what about is it? There's always a chance of infection. But the problem is, is that we've got him covered from that standpoint. If an infection occurs, guess what, we will treat it appropriately but right now there's no evidence of that.

JEFFREY BROWN:

Mr. Whittington's doctors say they have consulted with White House doctors since the shooting occurred. This afternoon, the vice president's office issued a statement. It spoke only of today's medically-related events, saying the vice president called Mr. Whittington and spoke to him. The vice president wished Mr. Whittington well and asked if there was anything he needed. The vice president said he stood ready to assist.

"Mr. Whittington's spirits were good but obviously his situation deserves the careful monitoring that his doctors are providing." The vice president said that his thoughts and prayers are with Mr. Whittington and his family.

DAVID GREGORY, NBC:

Just a few questions to follow up on the accidental shooting by the vice president —

JEFFREY BROWN:

Earlier in Washington there was another contentious White House briefing as Press Secretary Scott McClellan was again on the receiving end of a barrage of questions surrounding the shooting.

DAVID GREGORY, NBC:

One final question, since that one wasn't answered: Is it appropriate for the vice president to have waited 14 hours after the incident before he spoke with local law enforcement officials? And do you think that an average citizen would have been accorded that same amount of time before having to answer questions about a shooting incident?

SCOTT McCLELLAN:

That was what was arranged with the local law enforcement authorities. You ought to ask them that question.

REPORTER:

Has the president directed Cheney or his office to handle things differently in a case like this if it happens again?

SCOTT McCLELLAN:

You can keep asking those questions. You're welcome to cover this issue.

REPORTER:

Has the president given any direction to the vice president's office about how things like this should be handled in the future?

SCOTT McCLELLAN:

I just told you that you can always look at these issues and find a way to do a better job in the issue. I'm not going to get into private conversations between the president and vice president.

JEFFREY BROWN:

Tensions in the White House press room have grown since the incident on Saturday, including an off-camera shouting match yesterday between Press Secretary McClellan and an NBC News correspondent.

JEFFREY BROWN:

We get two updates on this story now: First the medical situation. For that I'm joined by Dr. David Pearle, a cardiologist and director of the Coronary Care Clinic at Georgetown University Hospital.

Welcome to you.

DR. DAVID PEARLE:

Thank you, Jeff.

JEFFREY BROWN:

From what you've been able to see, and from what you have been able to read, how serious is this?

DR. DAVID PEARLE:

Of course I'm not directly involved. I'm hearing the news stories. It's a serious problem that warrants concern but is probably not going to be life threatening.

JEFFREY BROWN:

We heard the doctors talk about a minor heart attack. They called it a silent heart attack, an asymptomatic heart attack. He's not had a heart attack in the traditional sense. What does all that mean?

DR. DAVID PEARLE:

Those terms are a little misleading as applied to this situation. Almost always when a heart attack occurs, it occurs because there's some kind of blockage or blood clot or ruptured plaque in the coronary arteries, the arteries that supply blood to the heart itself.

But a coronary angiogram was performed this morning and at least as was said in the press conference, Mr. Whittington's coronary arteries are quite good and this was not a heart attack in the traditional sense of a blocked coronary artery.

In that traditional sense, we call a heart attack that is not characterized by pain a silent heart attack. Maybe as many as one in four heart attacks the patient really experiences no pain at all or a very trivial amount of pain and that's what we would refer to as a silent heart attack.

So this is something very different. This is really bird shot that penetrated the chest to get immediately adjacent or even into the heart and is damaging the heart by the direct force of the bird shot.

JEFFREY BROWN:

Is there some way to know which it is; in other words, does the bird shot get into the skin and then move?

DR. DAVID PEARLE:

It certainly can move small distances once it gets there but not across large distances. This one bird shot pellet that they were — that they're concerned about must have arrived very near to the heart or possibly even into the heart at the time of the initial trauma, although there may have been some minor movement once — over the last twenty-four to forty-eight hours.

JEFFREY BROWN:

So what does it actually do to the heart?

DR. DAVID PEARLE:

Well, I mean in the worst case scenarios it perforates the heart and you can bleed out very rapidly in a periods of seconds to minutes if there's actually a hole in the heart. That obviously did not happen. The heart can penetrate — the bird shot can penetrate part way into the heart and just cause physical damage to the heart muscle where it strikes.

If it's sort of adjacent to the heart, it can irritate the lining of the heart or the pericardium; and that kind of inflammation can cause some heart damage and can lead to the kind of irregular heart rhythms that Mr. Whittington has apparently had.

JEFFREY BROWN:

Now you'll tell me if that is unfair question but yesterday the doctors were talking about him as being in very stable condition. And then today this happens. Does that suggest that something happened or they missed something yesterday? Why would that have happened?

DR. DAVID PEARLE:

I don't have the precise details but my guess is what happened is this: When the heart is damaged by the conventional mechanism or by something like this, it releases certain chemicals or enzymes into the blood. That's how — one of the ways in which we diagnose a heart attack and my guess is the enzymes were elevated.

The thing that very clearly happened is he developed these irregular heart rhythms that then focused attention on was there a direct cause. So I'm sure it was combination of those factors that made them become concerned about the heart.

Presumably the bird shot could be seen on an X-ray or CT scan, although it doesn't localize it quite as precisely as you'd like. So clearly attention was focused on it presumably by new symptoms, the arrhythmias and release of enzymes.

JEFFREY BROWN:

There seems to be a decision made to leave the pellets in the body under the skin.

DR. DAVID PEARLE:

Right.

JEFFREY BROWN:

Is that a normal decision? Can people walk around, live fine with pellets in them?

DR. DAVID PEARLE:

Soldiers walk around with shrapnel embedded all the time.

It's always a decision whether the metal object is likely to cause more harm than an operation to remove it. To remove the bird shot would be a major operation. One would have to crack the chest cavity, much as we do in coronary bypass surgery, to get near the heart, to remove it.

And I suspect the judgment has been made that the operation carries much more risk than the bird shot itself. There are things that could happen that would change that risk-benefit calculation, for example, an infection, which probably would require a removal of the foreign object.

JEFFREY BROWN:

All right, Dr. David Pearle, thanks very much.

DR. DAVID PEARLE:

Thank you, Jeff.