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President Yar’Adua’s ailment complex but treatable – Doctors

Cause of Yar’Adua’s ailment still unknown, *Report on Pericarditis*List of ailing Presidents,  what the constitution says

Renal failure is an established cause of pericardial disease, including pericarditis and pericardial effusions, and a less frequent cause of chronic constrictive pericarditis
Renal failure is an established cause of pericardial disease, including pericarditis and pericardial effusions, and a less frequent cause of chronic constrictive pericarditis

Who is in charge in the event of Presidential disability? This is the question that has been agitating Nigerians at home and abroad since the news of President Umaru Yar’Adua’s health condition broke.

The concern is based on developments which show that the President has a life-threatening condition that incapacitates him from carrying out his official duties effectively, knowing fully well that constitutionally, the Vice President has never really been in charge whenever the President is not available.

From history, it is generally observed that any condition in which the President is unable to exercise the powers and duties of his office, the expectation is that the Vice President should stand in. However, history tells us that 10 American presidents were disabled while in office. In six instances, the disability resulted in the President’s death.

In 1841, William Henry Harrison was bedridden for a week before dying of pneumonia. Zachary Taylor was bedridden for five days before his death from an acute intestinal obstruction in 1850. Abraham Lincoln was unconscious for nine hours before dying of a gunshot wound in 1865.

James Garfield was bedridden for 80 days and William McKinley for eight days before they died from gunshot wounds. Warren Harding was incapacitated for four days before his death from food poisoning (or a heart attack).

Four Presidents recovered from major disabilities. Woodrow Wilson was incapacitated with a stroke for 280 days. During that time, his wife communicated to government officials from his bedside, refusing to allow cabinet secretaries to see her husband while he was making his slow and only partial recovery. Dwight Eisen-hower was incapacitated for 143 days by his first heart attack in 1955 and later convalesced from a stroke.

He was also incapacitated briefly during an operation for ileitis. Ronald Reagan was incapacitated for 20 hours while undergoing surgery after suffering a gunshot wound in 1981 and later while undergoing surgery for colon cancer.

In all these situations, the American constitution never made mention of the procedures involved when a President is disabled and the Vice President must assume the duties of the office as acting President. This was so, until, the 25th Amendment to the Constitution.

In similar terms, nothing in the Nigerian 1999 Constitution compels the President to allocate to his deputy any significant executive power even in the event of the President being incapacitated. In this light, the office is at the mercy of the President who may decide to render the office impotent. Saturday Vanguard’s health crew of Sola Ogundipe & Chioma Obinna take a critical look at pericarditis – the health disorder that the Nigerian President is currently battling with. They also seek doctors views on the ailment .

“For once, we need to commend the Presidency for coming out straight with the true situation of the President’s health which is the business of the whole nation,” says Dr. Adedamola Dada, Chairman, Nigerian Medical Association, Lagos State Branch.

Dada argued that Yar’Adua’s health should be public knowledge because the nation’s fate is in his hands but lamented that  it is embarrassing to any patriotic Nigerian that we have to fly our President abroad for treatment when there are more than enough medical experts here. “It just goes to emphasise what we have been saying that we need to improve our health system.

Many Nigerians have come down with pericarditis and they have been successfully treated. The challenge is for us to improve our health system so that our President and every other person requiring medical treatment can obtain it here.

“I can only tell you that pericarditis is an inflammation of the encasement of the heart membranes which produce some fluid covering the heart. When inflammed, the fluid production increases and significantly affects the function of the heart.

The truth is that pericarditis is a complex disorder. The effects can be severe depending on the cause, whether it is acute or chronic. It is serious in nature but it is quite treatable.  Pericarditis is said to be  primary in nature if it is caused as a result of a problem within the heart and secondary if caused by a complication with another organ in the body. In the case of the President,  we are not told the cause and I cannot speculate.”

According to Dr. Ranti Familoni, Consultant Cardiologist with the Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Ogun State, acute pericarditis is an inflammation of the sac surrounding the heart called the pericardium. He says it is a common complication of kidney failure, which could have occurred due to a virus.

Familoni noted that even with kidney transplant done, this could not prevent a patient from developing acute pericarditis, a problem that can affect both the young and the old.

“Although, acute pericarditis is an emergency situation in children, because it causes the heart to be caged and unable to pump blood as it should, Familoni explained that in the case of the president, it was really not an emergency since it is a common complication in people with kidney problem.”

In the case of President Yar’Adua, he explained that this may not kill him since they know he has a kidney problem and as such, they would just go on and treat appropriately.

According to the expert, the commonest cause of acute pericarditis in adults is tuberculosis. Its symptoms include chest pain or tightness, often worsened by deep breathing. Its symptoms and signs also vary, depending on the severity of inflammation and the amount and rate of  fluid accumulation.

Pericarditis in renal failure

Renal failure is an established cause of pericardial disease, including pericarditis and pericardial effusions, and a less frequent cause of chronic constrictive pericarditis. Advances in management have decreased the incidence of pericarditis in patients with renal failure but the problem is still associated with significant morbidity and occasional mortality.

Uremic pericarditis is observed in 6-10 percent of patients with advanced renal failure (acute or chronic) before dialysis has been instituted or shortly thereafter. Similarly, dialysis-associated pericarditis — occurs in approximately 13 per cent of patients on maintenance hemodialysis and may occasionally be seen with chronic peritoneal dialysis.

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General information on chronic pericarditis


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