Take it to Heart

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Take it to Heart
The passing out started about 15 years ago. Once, he hit the ground while removing a screen from his truck. Another time, he fell off a ladder, breaking four ribs. Then there was the incident where he fell down the stairs, requiring 14 stitches.

“A lot of people thought I was clumsy,” says Lloyd F. Ward of Sugar Loaf, a retired state trooper.

His doctors were baffled. Although epilepsy was an early suspect, Ward says the doctors were not completely comfortable with their diagnosis.


Suneet Mittal, M.D., a cardiac electrophysiologist at The Valley Hospital’s Heart & Vascular Institute, stresses that no one should ever ignore a syncopic – or fainting – episode. Syncope is defined as an abrupt, transient loss of consciousness – which then returns.


“You should go to a trained medical professional, where a history (of the event) will be taken and an exam given, including an EKG,” he says.


Causes of fainting


• The most common is reflex syncope, experienced by about a fifth of the population – and a fifth of those more than once – he says of the episodes that can be prompted by such things as the drawing of blood; being startled; or being in a crowded, hot room.


• A defect in the heart muscle or valves, which will typically be revealed in an echocardiogram.


• Irregular heartbeats, or arrhythmias, either tachycardia – too fast, or bradycardia – too slow.


• Neurological causes such as seizures or epilepsy.


• Psychogenic syncope, which is emotional distress that can mimic a true loss of consciousness, but isn’t.


If a patient is younger than 40 and has a normal echocardiogram, the cause is probably reflex, Mittal says, but that should not be assumed by the patient.


“But with patients older than 40, you start to worry about arrhythmias. The heart ages, too,” he says.


Throw in high blood pressure, high cholesterol, medications, and it’s no surprise there’s a sharp increase in syncope after age 70.


“That’s where we need to do a little detective work,” he says. “And thanks to this new technology, we can now connect two incidents (as in Lloyd Ward’s case) 18 months apart.”


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A stress test revealed coronary artery disease; he had a stent procedure in 1997 and thought he would be OK. But the following spring, he had another episode.

“As best I can recall, I’ve had about seven or eight,” he says.

The pivotal episode happened about a year and a half ago. “I was working at the computer, looking at emails,” Ward says. “The next thing I know, I’m on the floor, gurgling. I could hardly move. “» That one broke my neck, and it was most terrifying. I could not communicate; even my throat was paralyzed.”


‘We just didn’t know’

Ward required emergency surgery and extensive rehab. The cervical fracture caused swelling, but not permanent damage to the spinal cord.

“We put him through every possible test and monitored his heart while he was hospitalized,” says Suneet Mittal, M.D., an associate professor of clinical medicine at Columbia University and the director of electrophysiology at the Valley Health System. “In the end, we just didn’t know.”


So Mittal advised that a loop recorder, also known as an insertable cardiac monitor — about the size of a stick of chewing gum — be placed next to Ward’s breastbone. This device records heart rhythms for three years.

“I had it done immediately. It never bothered me, didn’t affect my lifestyle,” Ward says.

However, in what he describes as “typical male fashion,” he didn’t return to his doctor’s office to have the recorded data downloaded as often as he should. And that day out fishing at the Jersey Shore last spring — when his stumbling prompted his friends to ask if he’d been drinking — didn’t register as a potential episode.

Several months later, the data was reviewed. “His heart had stopped,” says Mittal of what is called a sinus arrest in this case, as opposed to cardiac arrest — which is an arrhythmia in the heart’s lower chamber and results in death if prompt medical treatment is not received. “People typically don’t die of sinus arrest because the heartbeat does resume.

“I inserted a pacemaker to ensure there was no chance of this happening again.”

Ward, who sailed through the pacemaker procedure two months ago, is looking forward to the first spring in more than a decade where he is not apprehensive of what might happen. He plans to fish, spend time with his three grandchildren, and get back into shape.

“I don’t have this hanging over my head,” he says. “I can go out by myself again. Life is good.”


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