A cardiologist who examined Lt. Gov. John Fetterman following his stroke last month said Friday the Democratic Senate nominee has a type of cardiomyopathy, a heart disease that makes it harder for the heart to pump blood to the rest of the body. He said the pacemaker-defibrillator Fetterman received — along with diet, medication, and exercise — should allow him to continue with his campaign.

The campaign disclosed the new medical condition for the 52-year-old in a news release, which also acknowledged that Fetterman had ignored his doctor’s advice for five years. They declined a request to make his physician available for an interview.

“The prognosis I can give for John’s heart is this: If he takes his medications, eats healthy, and exercises, he’ll be fine,” said Ramesh Chandra of Alliance Cardiology in a letter provided to the media. “If he does what I’ve told him … he should be able to campaign and serve in the U.S. Senate without a problem.”

Fetterman’s May 13 stroke, four days before the primary he won handily, has taken him off the campaign trail and largely out of the public eye since. As he’s recovered at home in Braddock, the GOP Senate race has been stalled by a recount between celebrity cardiothoracic surgeon Mehmet Oz and former hedge fund executive David McCormick.

The Allegheny County cardiologist who examined Fetterman on Thursday said the candidate ignored his advice back in 2017, when Fetterman was experiencing swollen feet and went to see him. Chandra diagnosed him then with atrial fibrillation (A-fib), a type of irregular heart rhythm, and prescribed medications, along with improved diet and exercise. The pumping ability of Fetterman’s heart also had declined, the physician said. He asked Fetterman to follow up in a few months.

“Instead, I did not see him again until yesterday,” Chandra wrote. “John did not go to any doctor for 5 years and did not continue taking his medications.”

‘I avoided going to the doctor’

Fetterman, 52, in a statement accompanying the letter from Chandra released by his campaign Friday, said he “wasn’t proud” of ignoring medical advice but wanted to be a cautionary tale for others.

“As my doctor said, I should have taken my health more seriously,” Fetterman said. “The stroke I suffered on May 13 didn’t come out of nowhere. Like so many others, and so many men in particular, I avoided going to the doctor, even though I knew I didn’t feel well. As a result, I almost died. I want to encourage others to not make the same mistake.”

The letter is the first information from someone who has examined Fetterman since his stroke. The campaign has refused to make Fetterman or the doctors who treated him at Lancaster General available for interviews.

» READ MORE: Fetterman dominated the Pa. Democratic Senate primary. Here’s how he won.

The letter and statement were released as some concern among Democrats had mounted over the health of their nominee in the critical race, and as cardiologists not involved with Fetterman’s care questioned his campaign’s explanation of his medical treatment.

Fetterman’s campaign and his wife, Gisele, had said he suffered from A-fib, leading to his May 13 stroke. That type of heart arrhythmia can indeed cause a stroke. But when Fetterman got the combination pacemaker-defibrillator four days later, they said the device was implanted to treat the A-fib.

That’s not what defibrillators are for, though — leading outside cardiologists to deduce Fetterman had some additional heart condition that the campaign did not disclose.

Fetterman has cardiomyopathy, doctor said

In Chandra’s letter, the cardiologist names that second condition: cardiomyopathy.

Among the various types of cardiomyopathy is one caused by Fetterman’s original condition, A-fib. When this irregular heart rhythm persists for too long in the left atrium (at the top of the heart), the muscular ventricles at the bottom of the heart must work harder, eventually weakening. But Chandra did not specify how Fetterman’s cardiomyopathy occurred, nor did he offer details on the severity of that condition.

» READ MORE: Fetterman got a defibrillator after his stroke. But doctors say the campaign’s story ‘doesn’t make sense.’

Chandra also suggested he may have been the one to explain to Fetterman the connection between cardiomyopathy and the use of a defibrillator.

“Yesterday, I talked to John about how, while [A-fib] was the cause of his stroke, he also has a condition called cardiomyopathy, which is why doctors in Lancaster chose to implant the device,” Chandra said.

Chandra said the pacemaker-defibrillator was working well, based on his examination. The campaign said doctors in Lancaster echoed the same after a checkup this week.

An implantable defibrillator, a device roughly the size of a tape measure, is placed in the chest of someone judged to be at risk of sudden cardiac arrest. That doesn’t mean the heart has stopped beating, but that it has stopped pumping — beating or even quivering with a dangerously fast, chaotic rhythm. The person soon blacks out, and unless treated within minutes, faces serious disability or death.

A defibrillator detects cardiac arrest within seconds, then delivers a shock that “reboots” the heart into normal rhythm. In many patients, the devices never need to be activated, instead sitting quietly in the chest. In those that do, the defibrillator restores normal rhythm more than 99% of the time.

Unclear when Fetterman will return to campaigning

In his statement, Fetterman said he regretted not taking prescribed blood thinners, which Chandra told him would have prevented the stroke (a blood clot in the brain). He did lose 150 pounds in 2018 to reduce stress on his heart at the time, he said.

“I thought losing weight and exercising would be enough. Of course it wasn’t,” he said. “I didn’t do what the doctor told me. But I won’t make that mistake again.”

» READ MORE: Many men don’t take good care of themselves. It's a problem as old as medicine.

Fetterman said doctors have told him to continue to rest, eat healthy, and exercise. He did not provide a timeline for his return to the campaign trail.

“It’s frustrating – all the more so because this is my own fault – but bear with me, I need a little more time. I’m not quite back to 100% yet, but I’m getting closer every day,” he said. “This race is so important for Pennsylvania and for the country. I’m going to be ready for it, and I can’t wait to get back on the trail.”

The new details about Fetterman’s heart health made sense to St. Louis-based cardiologist Anthony Pearson, who had previously written about the case in his blog, The Skeptical Cardiologist. He said he often sees overweight men in Fetterman’s age group who are unaware they have A-fib.

“They don’t seem to know when they’re in atrial fibrillation,” Pearson said Friday in an interview. “They only come to the doctor because they can’t breathe anymore, or in his case it looks like it was edema [swelling]. Even when you tell them their heart is going 140 beats a minute, it surprises them.”