EXPLAINER: What do we know about John Fetterman’s diagnosis?

HARRISBURG, Pa. (AP) — John Fetterman, Pennsylvania’s lieutenant governor and a top Democratic candidate for U.S. Senate, is recovering from a stroke he said was caused by a heart condition called atrial fibrillation.

Fetterman said in a statement Sunday that doctors believe he’s on his way to making “a full recovery.”

A look at what happened, the diagnosis, the future of Fetterman’s campaign and what can cause A-fib.

WHAT HAPPENED?

It was on Friday morning when Fetterman’s campaign first canceled an event. The campaign’s communications director, Joe Calvello, told scores of people waiting to see Fetterman at Millersville University that he hadn’t been feeling well that morning and had to cancel.

The campaign canceled more events Friday and through the weekend, saying nothing about his condition or whereabouts. They revealed Sunday afternoon that he had suffered a stroke and was hospitalized.

In a 16-second video released by the campaign with the statement, Fetterman and his wife, Gisele, appear together, with Fetterman seated and speaking clearly.

“As you can see, we hit a little bump on the campaign trail,” she begins.

WILL THIS AFFECT HIS CANDIDACY?

Fetterman, 52, maintains that his candidacy will continue, that he’s feeling much better and that he’s expected to make a full recovery.

However, it’s not clear when he will get out of the hospital in Lancaster or whether he will attend the primary night event that his campaign had scheduled in Pittsburgh on Tuesday.

Fetterman suffered the stroke in the busy sprint in the last days of the primary campaign, when he had a full schedule of travel and public events around the state.

While campaigns can slow down a bit in the weeks after a primary, the campaign did not say whether this will affect Fetterman’s schedule or what sort of doctors’ visits or medication will be required in the future.

Fetterman said the campaign itself “isn’t slowing down one bit.”

Nothing else changes. Fetterman remains in the race and on the ballot along with the three other Democratic candidates.

WHAT’S THE DIAGNOSIS?

Fetterman said in the statement that he had a stroke that was caused by a clot from his heart being in “an A-fib rhythm for too long.” The doctors quickly and completely removed the clot, reversing the stroke, Fetterman said.

Blood can pool inside a pocket of the heart, allowing clots to form. Clots then can break off, get stuck and cut off blood, often in the brain, which receives substantial blood flow.

Fetterman did not say by what method the doctors removed the clot. His campaign said his exact treatment regimen is still being worked out, but will include rest in the short term and a healthier diet.

Dr. Donald Lloyd-Jones, a cardiologist and chair of the Department of Preventive Medicine at Northwestern University, said clots can be removed with “clot-busting” drugs or, more commonly, by extracting the clot “mechanically” by inserting a catheter through a big artery in the groin.

The longer a clot blocks an artery, the more brain cells can die, so it is critically important to recognize the symptoms of a stroke, said Lloyd-Jones, who is president of the American Heart Association and the American Stroke Association

People who develop A-fib are almost always put on a blood-thinning medication for the rest of their life to help prevent the stroke-causing blood clots that untreated A-fib can create, Dr. Lloyd-Jones said.

WHAT IS A-FIB?

A-fib — or atrial fibrillation — occurs when the heart’s top chambers, called the atria, get out of sync with the bottom chambers’ pumping action. It’s a type of irregular heartbeat that’s potentially serious but treatable.

In that abnormal rhythm, the upper chambers beat so fast that they can’t contract like they normally do. As a result, they don’t move blood effectively, so the blood can stagnate in the upper chambers and form a clot, Lloyd-Jones said.

Sometimes patients feel a flutter or a racing heart but many times they’re not aware of an episode. Sometimes the heart gets back into rhythm on its own. Other patients get an electric shock to get back into rhythm.

A-fib causes 130,000 deaths and 750,000 hospitalizations a year in the U.S. Between 2% and 3% of adults in the U.S. in Fetterman’s age range have had a stroke, and a substantial number of those are caused by atrial fibrillation, Lloyd-Jones said.

HOW DO DOCTORS CHECK FOR IT?

A-fib is most common in older adults, and other risks include high blood pressure, sleep apnea or a family history of arrhythmias. Obesity is also a significant risk factor, as is being taller, Lloyd-Jones said.

Fetterman is 6-foot-8, has been open about his push to lose weight in the past. He weighed in at over 400 pounds before losing nearly 150 pounds in 2018.

Routine screening isn’t recommended for people without symptoms. Studies haven’t yet proved that early detection from screening would prevent enough strokes to outweigh risks from unnecessary testing or overtreatment.

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