Harry Truman: Cardiac Asthma


cardiac asthma
 
Truman's diary entry for March 7, 1947 says: "Doc tell's [sic] me I have Cardiac Asthma! Aint that hell. Well it makes no diff, will go on as before. I've sworn him to secrecy! So What!" 1. Many years later, Truman's physician, Dr. Wallace Graham, recalled: "whenever President Truman would get into tight pinches, or really clutched up, he would have a little bubbling in the lungs, and he would have a little rale [a lung sound often caused by fluid in the lungs] at the base of his lungs" 1. Graham, who admitted he withheld information about Truman's health from the public, used diuretics (fluid pills) to treat the condition, sometimes staying up all night with the coughing Truman 1. SEE BELOW

Comment: (#1) "Cardiac asthma" is a little-used term today. It is often equated with pulmonary edema (fluid in the lungs), but a 1946 cardiology textbook 2a makes a clear distinction, noting that cardiac asthma can occur without pulmonary edema. Cardiac asthma is asthmatic-type breathing ("asthmatic respiration is a particular type of dyspnea") caused by sudden congestion of the pulmonary circulation. There may or may not be interstitial edema. Both cardiac asthma and pulmonary edema are generally considered to be manifestations of heart failure.

Comment: (#2) Cardiac asthma is usually due to a major mechanical malfunction of the heart and can be rapidly fatal. Unless the cause is something reversible, such as uncontrolled hypertension, a person who is having episodes of cardiac asthma will continue to have them. It apparently did not take much to tip Truman into cardiac asthma in 1947. How did he manage to survive for another 25 years? He was not then hypertensive. One wonders if the diagnosis was correct.


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Excerpts from Dr. Wallace Graham's 1989 oral history were published in 1. The full history is deposited at the Truman Library.

Graham had been tipped off by another physician in 1945 that Truman had pulmonary edema. He reports telling the President:

whenever you get up to your heights of tension and you're under a lot of stress, that your lungs are producing a little more fluid than usual. ... I don't notice it in your feet, or your legs; they don't swell, or anything of that type, but it's in the base of your lungs.
Graham further states:
And I gave him a little diuretic, I think, occasionally, and that's all there was to it. It seemed like when he recognized the fact he wouldn't allow himself to get all keyed up or tense.
Graham said he sometimes stayed up all night with the president "trying to dry his lungs up and all. I had him sitting up, and coughing."

In his oral history, Graham does not mention "cardiac asthma." In fact, he calls it pneumonitis (a bland term meaning inflammation of the lungs). When asked if this was the worst health problem Truman had, Graham said "Probably so."

The Post article 1 quotes a cardiologist in 2003 saying that Graham may have given Truman "a simple diuretic." Today, diuretics are, indeed, a simple thing. In 1947 the available diretics were more toxic, and included mercury, theobromides, bismuth, and arsenic 2b. Morphine was then known as an effective treatment for acute cardiac asthma 2c. Nitrates are extremely effective as well, and digitalis can also be used (this is not medical advice).

Cited Sources
  1. Huget, Jennifer. The secret heart of Harry Truman: Diary reveals diagnosis of "cardiac asthma": hushed up then, obscure still. Washington Post. July 22, 2003; page HE01.
        

    Comment: Accessed through washingtonpost.com: http://www.washingtonpost.com/wp-dyn/articles/A25477-2003Jul21.html There is also a substantially inconsequential correction published the next day: http://www.washingtonpost.com/wp-dyn/articles/A31867-2003Jul22.html

  2. White, Paul Dudley. Heart Disease. (3rd ed.). New York: Macmillan, 1944; 4th printing May 1946.
        
    a  p.29  b  pp.782-785  c  pp.785

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