| | By Martha Ross
In October 2011, I thought I was pretty healthy for 48. While not athletic, I exercised daily and tried to eat sensibly. A physical exam over the summer showed that my blood pressure was fine and apparently so was everything else. But on a Sunday afternoon, I passed out while at home. And in the emergency room, my heart just stopped.
Surviving this episode meant entering a new kind of existence where I am now one of those people who has a heart condition. And, if it weren't for developments in modern medicine, I would probably be living a very limited life, like some chaise-confined heroine in a Victorian novel. Or—and I still can't get my head around this possibility—I might not be alive at all.
My condition is actually somewhat common, or more common than people think. I have an arrhythmia—an abnormal heart rhythm caused by electrical impulses that have gone haywire.
There are many different kinds arrhythmia. Some cause the heart to beat too quickly; others, too slowly or too erratically. They afflict people of all ages, including children and otherwise healthy young adults, though most arise in people who are older or who have underlying heart disease, high blood pressure, and other health problems.
Some arrhythmias are harmless, and many people have experienced times when they felt their heart racing. Heart palpitations are also common in women in perimenopause. But some arrhythmias, like mine, are life threatening and need medical intervention. In fact, arrhythmias are the leading culprits in sudden cardiac arrest, which can strike without warning and result in as many as 325,000 adult deaths a year.
Hindsight shows that my heart's malfunctioning electrical system was making itself known a month or two leading up to my emergency room visit, but the symptoms were subtle enough that I dismissed them. Susan Eisenberg, a cardiac electrophysiologist with John Muir Health, says some of her patients likewise complain of vague symptoms. A few come into her office, with hearts racing at 160 beats per minute, but they don't feel anything. She adds that women are most likely to dismiss symptoms. "Any chest pain, palpitations, or an irregular beat—those are important symptoms to pay attention to," she says.
In my case, I would try to go running, but poop out after going just a few blocks. Walking up hills also became a new challenge, as did ascending a flight of stairs. When I reached the top, I'd feel short of breath. As for the running, I thought, "I'm just being lazy, or I'm bored with running. I need a new routine. I need new shoes." It didn't occur to me to go see my doctor.
On that Sunday, I had gone to the gym, come back, and was sitting at my kitchen table looking at the newspaper. And then it came over me. There was no pain, and no dizziness in the usual sense. It was as if the ground beneath me was disintegrating, and fragments were rising up to swallow me into a gray-green aura. In the milliseconds of remaining consciousness, I got myself to the floor so I wouldn't fall off the chair and slam my head into something on the way down.
That's the last thing I remember until I saw my husband bending over me, holding me up against the dishwasher. Minutes later we were on our way to the emergency room at Walnut Creek's John Muir Medical Center. A triage nurse, suspecting I had not suffered an ordinary fainting spell, got me into an examination room. She found that my blood pressure and heart rate were normal. I was even starting to feel OK. An EKG also showed nothing unusual.
But over the next hour or so, I passed out six more times. While slipping away during episode No. 3, I heard a doctor announce "she's asystole." From TV medical dramas, I knew that "asystole" meant flatlining—not a good thing. My husband later told me he watched the green number on the heart monitor's black screen fall from 60-something to below 50, and then to zero. And it stayed at zero for five or 10 seconds. Someone came rushing in with a red crash cart, one of those cabinets on wheels with a defibrillator and other life-saving equipment, but they didn't need to use it because my heart would start up again.
Fortunately, I was in the right place. The monitors were telling the hospital staff what they needed to know, and within a few hours I had a diagnosis.
I had sick sinus syndrome. The attending cardiologist, Perkin Shiu, who is now my doctor, said the source of my problem was the sinus node, an area of cells in the heart's upper right chamber that are known as the heart's natural pacemaker. This malfunction was causing a type of arrhythmia known as "bradycardia." That's a slow heart rate. My bradycardia was intermittent, Shiu said, with my heart slowing in sudden, unexpected ways.
Shiu couldn't offer any definitive reason for why this was happening to me. Sometimes, in very unusual cases, arrhythmias just happen, Shiu said. I had no underlying heart disease, hypertension, or diabetes, and I had not damaged my heart through smoking or drug abuse. The best possible explanation he could offer is that I had a genetic predisposition: my father was diagnosed with an arrhythmia in his mid-50s, for which he took medication the rest of his life.
For me, Shiu's recommendation was to have a pacemaker implanted as soon as possible.
A pacemaker is the typical treatment for a slow heartbeat if there isn't a cause that can be treated with medication. For fast heartbeats—called tachycardia—doctors use other treatments including: blood-thinners; electric shock to reset the heartbeat; ablation, in which catheters are threaded into the heart to destroy the source of the arrhythmia; and surgery for cases that don't respond to anything else.
I had surgery the next morning at 7:30. Actually, the word "surgery" in my case makes the procedure sound more dramatic than it was. It was very "outpatient" in that I was just given a local anesthetic and was awake as Shiu made a small cut in the muscle above my left breast and threaded a lead to my heart. The lead was a wire that would carry the electrical pulse to my heart from a coin-sized battery-operated generator—the pacemaker—that Shiu slipped into a pocket of skin next to my left armpit.
I stayed one more night in the hospital and went home the next day. Shiu said I didn't need to take medication or make drastic life-style choices, though, as with anyone my age, I should maintain a healthy diet and not over-indulge in coffee, alcohol, or anything else. Shiu said my heart was otherwise in good shape, meaning I didn't have any "structural" problem associated with heart disease.
Shiu encouraged exercise once the incision healed, and said I could be as active as I wanted, even training for marathons or scaling mountains. A major thing to avoid moving forward would be airport security gates, where my pacemaker could set off alarms. I now carry a pacemaker identification card that I can show to Transportation Security Administration officers and request a pat down or private screening.
My pacemaker is set to electrically stimulate my heart to speed up if the rate falls below 60 beats per minute. During a recent exam, a read-out of my pacemaker's activities for the previous six months shows my heart relied on it 11 percent of the time.
The battery in my pacemaker should last a good 10 years, and I'll probably go through another three or four of them before I'm done, Shiu said. Or, pacemakers—which used to be Walkman-sized devices you'd wear on a belt—will advance to the extent that they become replaced by treatments that are even more permanent and less invasive.
I feel fortunate in most ways. I passed out while at home, with my husband. I didn't collapse while walking on the street or when I was driving a car. I also got to an emergency room, and the episodes continued long enough for hospital staff to be able to "capture" a read-out of my faltering heart rate and determine a diagnosis.
I have a two-inch scar on my upper chest, and it is weird to sometimes feel a strong pulse coming from that area or be able to feel a quarter-size plate beneath the skin. It's a bit unreal, and reminds me of the fact that I'm not as physically sturdy as I once believed and that I am reliant on this device to stay alive.
But for the most part, I'm not burdened by my arrhythmia. In fact, I probably have more energy than I did pre-pacemaker. I joke about having a bit of bionic woman in me. And, I do feel like I could train for a marathon, though I'm not really inclined. Running for 26 miles sounds a bit tedious. Still, it's nice to have that option.
Martha Ross is a former co-editor of The Monthly and now writes features for Bay Area News Group.
Margaretta K. Mitchell is a nationally known artist and professional photographer, author, and educator based in the San Francisco Bay Area. To explore the possibility of Mitchell shooting a portrait for the web or print, an environmental portrait, or a creative portrait of your fantasy persona: (510) 655-4920 or margarettamitchell.com.
(top) Martha Ross relies on a pacemaker to control her heart condition, sick sinus syndrome; (bottom) Ross at Lafayette Reservoir. Photos by Margaretta K. Mitchell margarettamitchell.com.