A Little About My Week...

So, my week started as normal as any other: an early Monday morning visit to Cardiac Rehab. Ten sets of ten reps with ten pound hand weights (one in each hand), check. Ten minutes on the rower, pulling 100 watts (I don't recall the strokes per minute), check. Fifteen minutes on the treadmill, but feeling it this Monday morning, so I've backed off from 3.6 mph to 3.5 mph, still running the 5% grade; heart rate is getting up over 150 bpm, sweat is building, and the calves are burning, but we got it done, check. Start on the evil arm machine, fifteen minutes in my sights at level 5, but not really pushing it as hard this time, settling on maintaining somewhere between 35 and 40 watts. Instead of half of it forward and half backward, swapping it up: 2.5 minutes forward, 2.5 minutes backward, and repeat toward the 15 minutes goal. After ten minutes, really starting to feel it, but I press on; at the 12.5 minute mark, starting to reverse direction, but then I'm really feeling not so well, a little weak, and light headed, so I decide to call it: stopping at 12.5. Sit at the machine for just a moment, then get up to go get a cleaning wipe to wipe down the machine. Rest against the center pole desk (where the wipes are) for a bit, then back and clean the machine. Then I head to the chairs (where you check in and start your cardiac rehab) to take a break.

One of the nurses (April) comes over and asks if I'm done for the day, but I reply that I'm just taking a break. I put my head down a little, as I'm really starting to get light headed, and then I remember dreaming a bit which morphed into staring up (from the ground) at a bunch of faces hovering over me. It takes a moment for me to realize where I am, but slowly it starts to come back, and I realize that I've passed out (per my wife, April caught me and helped lower me to the floor to prevent any hard falls, and then the whole cardiac rehab nursing staff and on-site doctor all spring into action). Before long, I have an IV in my arm, and then paramedics have come in with their gurney. (Just that morning I'd seen this on Facebook: why do EMTs always go out in twos? Otherwise, they wouldn't be pair-o'-medics!) The cardiac rehab staff print off the portion of the ECG around my syncopal episode, where it seems my heart had suddenly (less than 20 seconds) slowed from over 100 bpm to around 20 bpm, which lasted for about 15 seconds (and overall, the bradycardia episode lasted around 24 seconds). After that, my heart rate just as quickly ramped back up to well over 100 bpm again. (I do have the recording of the ECG from the entirety of my cardiac rehab session on Monday, which is certainly an interesting thing to view.)

The next portion of my Monday was a very expensive taxi (ambulance) ride around the corner (the cardiac rehab center is behind the hospital, but not directly connected, hence the ambulance ride essentially a block or two to the ER). I spent the rest of the morning in the ER, where every test seemed to come back normal (ECG, x-ray, troponin level; note that ECG and x-ray also came back normal in the ER when I was having a heart attack on Dec. 31, but in that case, troponin levels - an enzyme released from the heart into the bloodstream when it's under stress or actively being damaged - were initially elevated to the point of "watch" and then quickly elevated throughout the morning, while in this case, troponin levels remained below the detection level). With that, I was no longer a priority cardiac patient, and quickly fell down the urgency list (unfortunately, the cardiac ward at the hospital was quite slammed with patients, urgent needs, and surgeries that day). Upon reviewing (and pointing out) the bradycardia, they decided to 1) stop the beta blocker (Metoprolol) that I was taking; and 2) admit me to the hospital for overnight observation on ECG telemetry (the ER nurse practitioner didn't think this was necessarily any big deal, but with my having had a heart attack and stent placed just in December, she really wanted cardiology to make the call, and cardiology had been backed up most of the day and finally got to my case, and wanted to do the overnight observation). They had also talked about the possibility of a loop monitor.

Because I came in due to a syncopal episode, I wasn't allowed to get up out of the bed without someone else present (so that, if I were to pass out again, someone would be able to alert the facility staff, either my wife, during visiting hours, or a nurse that I would have to call to attend my rising). In case you're fortunate to never have had the pleasure of being a cardiac patient, I'll let you know that they want to keep tabs on your fluids in and out, meaning they track the amount of liquids you're ingesting (or taking via IV) and also want to know how much urine you're producing, so you get to tinkle in this fancy plastic measuring device:

Then you get to tell the nurse how much urine you've gifted them (I just noted the amount, poured it into the toilet and flushed, and wrote it on the board in the room). Speaking of those visiting hours, they were quite silly, in my opinion: 8-11 AM and 4-6 PM. Apparently Covid is less contagious during those hours? But, seriously, you'd think having the visitor have to leave and re-enter the hospital and room twice daily would be more likely to bring infection than simply staying in the room without leaving (and/or entering/leaving once/day).

So, back to Monday. Never saw another doctor after getting to the hospital room, only the nursing staff. Already, though, I knew they were going to observe overnight. Tuesday morning, almost into noon, shortly after 11 AM, the hospitalist (doctor) stopped by, anticipating that he'd noticed a little bradycardia overnight, but nothing he's concerned about. From that, he expected that they would likely have me discharged, but again, he was deferring to cardiology.

And the wait begins. Cardiology was, once again, slammed, and it wasn't until after 7 PM Tuesday evening before the cardiologist came by. He said they wanted to do a tilt table test in the morning. Unfortunately, this also meant (per the nurses, I later found out), back to the "NPO" ("Nothing Provided Orally" - which includes water) after midnight; fortunately, at least they had decided that I could get up on my own, which made it easier to get up to go to the bathroom instead of having to call and then wait for a nurse. Further unfortunately, however, the cardiac group was again slammed on Wednesday, and it wasn't until about 1:30 that I went down for the tilt table test (so, nothing to eat or drink, even water, since midnight the night prior). On the way down to the tilt table test, I heard "code blue" and a room number, and a lot of nurses and physicians running (literally) back in the direction from which I'd come, and so I realized there are definitely worse things than having to fast for nearly 14 hours.

The tilt table test was interesting, but didn't really seem to show anything - it was "normal" per the cardiologist (who I didn't see until well after 6 PM). And they finally discharged me, Wednesday evening, with instructions to follow up with my cardiologist and primary care physician next week. There really wasn't that much info provided, certainly nothing definitive to explain what happened, just some possible ideas. They seemed to attribute the passing out to vasovagal syncope, possibly aggravated by the beta blocker (Metoprolol), which is why they wanted to observe the ECG after stopping that medicine (but, to note: I haven't had such an episode at any point prior to Monday morning, despite being on the beta blocker since Jan 1, about two months prior). I suspect I may have a stress test after vising my cardiologist Wednesday, and possibly a Holter or loop monitor for some period of time as well, but it's still odd, having this episode now, two months after the heart attack and stent. I also hated having to take yet another week of paid time off from work - I'd already planned to be out of town on Friday (as my lovely daughter, 8 months pregnant, was performing an opera that had been postponed from last year due to Covid), and I was in the hospital Monday through Wednesday, and took Thursday as a day of recovery from the hospital visit (I was tired from "hospital sleep" and had been away from home, unexpectedly, for three days). Alas, it is what it is, and I suppose it's better to be using the PTO now than to have it added to a "final paycheck."

Take care of yourself. Get your cholesterol checked, eat better than you think you should, exercise, and pay attention to any abnormal signs - back pain, chest pain, jaw pain, unexplained tiredness, etc. Better safe than sorry (even if you have ginormous deductibles on your insurance that you're paying too much for in premiums).