Former New York City Mayor Ed Koch died Friday at the age of 88.
The revered politician battled an assortment of health problems throughout his life – all of which could have contributed to the cause of his death: congestive heart failure, according to one doctor.
In 1987, he suffered a minor stroke. Then, in June 2009, he had surgery to replace his aortic valve, and later that month, he had gallbladder surgery. In 1991, Koch had a pacemaker inserted, and eight years later, he was hospitalized for a heart attack.
In 2001, Koch was hospitalized again with pneumonia.
Koch returned to the hospital twice in 2012 – once in September for anemia and again in December for a respiratory infection. In January 2013, he was hospitalized for fluid buildup in his lungs, which is also known as edema, a side effect of congestive heart failure, said Dr. Nieca Goldberg, medical director of Joan H. Tisch Center for Women’s Health at the NYU Langone Medical Center.
Goldberg did not treat Koch.
On Thursday, Koch’s spokesman issued a statement that the former Mayor was in the intensive care unit at New York Presbyterian Hospital so his cardiologist could monitor him more closely.
“Heart failure means there seems to be a problem with the heart and the strength of its contractions,” Goldberg said. “And, edema causes a shortness of breath.”
Goldberg said while the causes for congestive heart failure are numerous, a heart attack, anemia and aortic valve replacement are certainly among them.
Heart attacks, depending on their severity and how much of the muscle is affected, can cause the heart muscle to weaken considerably, she noted.
Also, suffering from anemia doesn’t help the matter; the condition depletes the heart of the oxygen it needs.
“If someone is anemic, it stresses the heart even more,” she added.
Other causes for congestive heart failure may include hormonal ones, like an underactive thyroid, in which case the congestive heart failure can be reversed.
In younger patients, Goldberg said a heart transplant can be considered, but because of Koch’s age and other health issues, he was not a likely candidate.
“People can live a long time with heart failure,” Goldberg said. “We’ve made advancements in the treatments … but it’s not as good as having a normally functioning heart.”
Five years ago, Koch paid $20,000 for a burial plot at Trinity Church Cemetery. At the time it was the only graveyard in Manhattan with available space.
“I don’t want to leave Manhattan, even when I’m gone,” Koch told the Associated Press. “This is my home. The thought of having to go to New Jersey was so distressing to me.”
Soon after he bought the plot, Koch purchased a tombstone, which he had inscribed with the last words of slain Wall Street Journal reporter Daniel Pearl: “My father is Jewish, my mother is Jewish, I am Jewish.”
The tombstone also includes a Jewish prayer and the epitaph, which he wrote in 1988, shortly after his stroke.
The Associated Press and FoxNews.com's Jessica Ryen Doyle contributed to this article.