Editor's note: Allan B. Schwartz, M.D., a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine, is looking at the health of U.S. presidents. On the eve of the Democratic National Convention, his subject is the Democrat who assumed the presidency in the final months of World War II.
To the public, President Harry S. Truman was always the picture of health, going for his long, daily "constitutional" at a vigorous 120 steps a minute. Family and close friends considered him a stoic who ignored illnesses.
In 1927, as a county court presiding judge in Missouri, Truman suffered anxiety and headaches, self-diagnosed as "sinus headaches." He sought relief by driving into the countryside.
While a senator, in 1937, Truman spent over a week at the Army-Navy Hospital in Hot Springs, Ark., for what were diagnosed as effects of overwork and job-related stress. He returned twice again to Hot Springs for rest and examinations, all kept tightly under wraps.
After just 82 days as vice president, Truman was sworn in as president on April 12, 1945, when President Franklin D. Roosevelt suddenly died.
"Boys, if you ever pray, pray for me now," he told reporters. "I don't know if you fellas ever had a load of hay fall on you, but when they told me what happened yesterday, I felt like the moon, the stars, and all the planets had fallen on me."
In July, he was off to the Potsdam Conference with Stalin and Churchill, and the following month made the call to drop atomic bombs on Japan, ending World War II on Aug. 14, 1945.
Less than two years later, Truman developed acute respiratory distress, with shortness of breath and wheezing. Later, Truman's physician, 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 [the sound of fluid in the lungs] at the base of his lungs."
Truman's diary entry for March 7, 1947, indicates: "Doc tells me I have cardiac asthma! Ain't that hell. Well it makes no diff, will go on as before. I've sworn him to secrecy! So What!"
What did the doctor's diagnosis mean?
Cardiac asthma, a term that's not much used today, got its name because of the symptoms: wheezing, coughing, or shortness of breath. But it is caused by congestive heart failure and has nothing to do with ordinary asthma. Because the heart is weakened, the left ventricle cannot pump enough blood, so fluid builds up in the lungs (pulmonary edema).
Medical science today knows much more about the impact of emotional stress on the heart in specific and the body generally than it did in the past. Multiple brain mechanisms, interacting, have been shown to share the same neural circuits responsible for cardiovascular system functional adjustments.
Truman's physician, Wallace Graham, diagnosed pulmonary edema but at his patient's request said nothing publicly.
Records since disclosed indicate that Graham recognized the stress connection, advising his patient: "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."
This observation, the doctor said, had an impact on his patient. "It seemed like when he recognized the fact he wouldn't allow himself to get all keyed up or tense."
Graham also gave him what he called "a little diuretic" to ease the edema, though exactly what that was has not been recorded. It is suspected that a mercurial diuretic was used.
Graham's treatment did appear to help; Truman went on to win election to another term in office, and lived another 25 years. He died at age 88 on Dec. 26, 1972, after a three-week hospitalization for "lung congestion, heart irregularity, kidney blockages, and a failing digestive system," wrote biographer David McCullough.
Essential to this discussion is that emotional trauma can precipitate congestive heart failure by flooding the system with adrenaline-like hormones and chemicals responding to threat, danger, and excitement.
In addition to addressing the causes of emotional stress, today's management of acute pulmonary edema due to stress cardiomyopathy could include medication including beta blockers to regulate heart rhythm, or intravenous drug therapy to decongest the lungs and improve heart performance, as well as emergency use of electrical current for severe arrhythmias.
Restriction of salt and fluids is essential in treatment of heart disorders plus combinations of diuretics, and medicines to preserve cardiac function and blood pressure.
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