It’s been more than a week since Lt. Gov. John Fetterman celebrated his win in Pennsylvania’s Democratic Senate primary from a Lancaster hospital, where he was recovering from a stroke and the implantation of a combination defibrillator-pacemaker. But the campaign’s explanation of his medical treatment doesn’t entirely make sense, according to cardiologists.
Fetterman’s campaign has said he’s on his way to a full recovery. Yet as that recovery continues at his home in Braddock, Fetterman hasn’t publicly answered questions himself about his health. And his campaign has refused multiple requests to interview his doctors, without giving any reason for that refusal. It’s left the full public picture of his health — and fitness for a six-year Senate term — unclear.
With Fetterman now the Democratic nominee in one of the most competitive and consequential Senate races in the country, the unanswered questions about his health have left some Democrats anxious — and cardiologists watching from the outside puzzled.
The uncertainty stems from how Fetterman’s campaign and his wife, Gisele, have characterized his heart condition: a common, irregular rhythm called atrial fibrillation (A-fib). They said the A-fib led to his May 13 stroke, and that is indeed a common cause of stroke. But when he got the defibrillator four days later, they said the device was implanted to treat the A-fib.
But that’s not what defibrillators are for, leading cardiologists not involved in his care to suggest that Fetterman, 52, has another heart condition the campaign hasn’t disclosed.
“It doesn’t make sense,” Anthony Pearson, a St. Louis-based cardiologist who writes The Skeptical Cardiologist blog, said of the campaign’s account of Fetterman’s health.
What is clear, physicians say, is that both of the procedures Fetterman underwent — removal of the blood clot in his brain (the stroke) and implantation of the defibrillator — are highly effective when performed promptly. And for that, his wife may deserve much of the credit. As the couple left a May 13 campaign event, Gisele Fetterman said she noticed the left side of his mouth droop briefly — a classic sign of stroke — and insisted they rush to the hospital.
“He doesn’t have any physical effects,” Gisele Fetterman said in an interview Wednesday from their home. “He’s feeling good. He’s feeling restless. He’d like to not be here, but he doesn’t really have a choice right now.”
What caused the stroke?
Fetterman’s medical woes began in 2017, the campaign said, when his feet suddenly began to swell — a possible sign of A-fib. He went to a hospital for tests, and doctors diagnosed him with the irregular heart rhythm, Gisele Fetterman told The Inquirer. She said his father and grandmother also had the heart condition, which can be hereditary.
Fetterman, who once weighed more than 400 pounds, announced in 2018 that he’d lost almost 150 pounds.
Still, five years after his diagnosis with the abnormal heart rhythm, he developed a blood clot that migrated to his brain: a stroke. In patients with A-fib, this can happen because the heart’s left atrium quivers with each beat, disrupting blood flow in a way that raises the risk of a clot.
Gisele Fetterman said her husband wasn’t being treated for A-fib at the time of his stroke. But that’s not necessarily a cause for concern, said Pearson, an adjunct clinical professor at Saint Louis University. Some patients have a few brief episodes of the abnormal heart rhythm, with no sign they will recur, in which case drugs and other treatment would not be warranted, he said.
On May 13, Fetterman arrived at Penn Medicine Lancaster General Hospital within minutes of his wife’s noticing his mouth droop. Doctors there removed the clot from his brain, the campaign said.
Physicians not involved with Fetterman’s care said his wife’s fast response was essential. If a blood clot in the brain is removed within hours, the patient can make a full neurological recovery, said Thana Theofanis, an endovascular neurosurgeon with Main Line Health-Jefferson Neurosurgery.
“I noticed something was off; he didn’t even want to go to the hospital,” Gisele Fetterman told supporters on primary night. “He didn’t want to miss the events we had planned, but I insisted. And as usual, I was right.”
Now that he’s had a stroke, his doctors may prescribe anticoagulants (blood thinners) to reduce future risk of clots, among other medications.
Why did Fetterman get a defibrillator?
An implantable defibrillator, a device roughly the size of a tape measure, is placed in the chest of someone deemed to be at risk of sudden cardiac arrest. Despite the name, that doesn’t mean the heart has stopped beating, said Joshua M. Cooper, director of cardiac electrophysiology at Temple University Hospital.
Cardiac arrest means the heart has stopped pumping — beating with a dangerously fast, uncoordinated rhythm that brings the flow of oxygenated blood to a near halt. The person soon blacks out, and unless treated within minutes, faces serious disability or death.
But an implanted defibrillator detects cardiac arrest within seconds, then delivers a shock that “reboots” the heart into normal rhythm.
The devices are implanted in patients who have recovered from cardiac arrest, in case they have another. They’re also used in people who’ve never had such an episode but are thought to be at risk of one, for any of a variety of reasons. Those include chronic coronary artery disease and problems with the heart’s electrical system, some of which are hereditary.
But one condition that defibrillators do not address is A-fib, Cooper said.
“It has nothing to do directly with atrial fibrillation,” he said.
While stressing that they have no direct knowledge of Fetterman’s medical situation, Cooper and Pearson said a defibrillator would never be implanted unless a patient had another condition besides A-fib.
That could mean some underlying heart condition was resulting in both A-fib and an increased risk of sudden cardiac arrest. Or it could mean the A-fib had been going on for a long time, leading to a weakened heart muscle that would necessitate the use of a defibrillator.
Either way, a defibrillator does not treat A-fib, a condition that arises in the left atrium, at the top of the heart. Instead, it shocks one of the heart’s lower chambers — the ventricles that pump blood.
Gisele Fetterman said that she had seen news reports with cardiologists questioning if her husband had a second heart condition, but that she knew of none other than A-fib.
“I saw ... speculations around his health by the doctors who didn’t treat him,” she said. “But the doctors who treated him, who are doctors, did not say that, no.”
Gisele Fetterman said her husband is monitoring his sodium intake and is prohibited from heavy lifting until a follow-up appointment at Lancaster General this weekend.
“We’ll know more then,” she said.
What’s life like with a defibrillator?
In any given five-year period, 9 out of 10 people with implanted defibrillators never experience cardiac arrest, Cooper said. The devices sit quietly in the chest, just in case. In those who do go into cardiac arrest, the devices successfully activate more than 99% of the time, delivering a shock that restores the heart to normal rhythm, Cooper said.
Those who have passed out from cardiac arrest never feel anything, typically waking up as if nothing happened. In those who remain conscious, the jolt can be unpleasant. In addition to shocking the heart, the device causes the contraction of other muscles in the chest.
“Some people describe it like a bomb went off in the chest,” he said. “Some people describe it like a brick or bat hit them in the chest.”
But given the alternative — severe, long-term disability or death — it’s a welcome event.
“Defibrillators are one of the most effective treatments we have in modern medicine in terms of preventing someone from dying,” Cooper said, “because of the immediate treatment response time, which is seconds, and the high effectiveness of that treatment.”
Fetterman’s health prospects
Gisele Fetterman has fielded questions about her husband’s health en route to the polls on primary day, at his primary night party, and in phone interviews since. She often talks about how lucky the family feels that Fetterman’s stroke occurred so close to a hospital with a major stroke treatment center. She’s also said Fetterman will use the experience on the campaign trail to talk about the need to expand emergency care to more rural parts of Pennsylvania.
“What he’s gonna want to fight for is to make sure that everyone would have access to the same care that he was able to receive anywhere you live in the country,” she said on primary night.
She has repeatedly defended her husband’s ability to campaign and be a U.S. senator. “I think anyone saying he isn’t fit to serve, that is an insult to every other stroke patient,” she said.
The campaign has not said when Fetterman is expected back on the campaign trail. His wife said he’s eager to resume.
“It’s a good time for a break, though,” Gisele Fetterman said, noting the recount in the GOP Senate primary. “We don’t even know who our opponent is on the Republican side, so this is a much-needed rest that he needs and deserves. We were planning to take a week off after Tuesday. It just came sooner than expected, but he’s here.”