What is Vasovagal?

(By Ted D. Nelson - January 4, 2014)

Happy New Year! How did you spend your first day of 2014? I spent over five-hours of mine in the ER at St. Josephs Hospital. It was a wonderful experience!

It was a little after noon time on January 1st, 2014. I was in front of our 65 inch TV occupying my favorite La-Z-Boy chair. (Although it has been targeted for replacement more than once, I have fought to keep my favorite chair which has been rebuilt several times in the last 43 plus years; it was a wedding present from my mother.) I was switching the TV back and forth between two football games, Nebraska verses Georgia and Wisconsin verses South Carolina; two very good games.

Suddenly I started experiencing what felt like cramping in my chest, (my left pectoralis major); it was quite annoying. After a short while, I got up from my chair to move around a bit to see if I could make the cramping go away. But the cramping intensified! I walked to the end of the couch next to my chair and leaned against the arm, the pain was indescribable and unbearable; my forehead began to feel damp and clammy. I had no idea what I was going through. I called out to Sandee but got no response (she was upstairs cleaning, we had had the pleasure of entertaining many family members over the Christmas holiday and she was in the process of restoring the house to its normal order). I put my fingers in my month and whistled loud enough to finally get Sandee’s attention; I heard her voice call out, “are you looking for me?”. This was no time to ‘beat around the bush’; I couldn’t believe the words that came out of my mouth as I shouted back, “I may be having a Heart Attack!” (“Could that actually be true” I thought to myself.)

The next thing I remember is waking up on the floor behind my chair; I was in a semi-fetal position; from my chest up, I was soaking wet and strangely, my ankle hurt, (just like it had so many times before when I had sprained it playing basketball or football). I could hear Sandee’s voice in the distant background; she was talking to someone on the phone. I heard her say “yes, he’s breathing and he’s awake now’. I concluded she had called 9-1-1; but it was so hard to believe that she was talking about me. “Here, put these in your month and chew them up quickly” she handed me four Baby Aspirin Tablets and then spoke into her phone, “okay, he’s chewing the aspirin now”.

I sat up with my legs crossed and leaned back against the end of the couch. I felt fine, the pain in my chest was gone; my head was still damp, but not clammy. My ankle still hurt; (I started analyzing why. I concluded that when I passed out and my body surrendered to the forces of gravity, all my weight initially came straight down flexing my ankle in the wrong direction).

I could hear the sirens in the distance getting closer; Sandee had all the lights on and the doors open as per her instructions received on the phone. In they came, just like they do in the TV shows. There was the guy wearing giant boots that looked like he was going to a fire, the female member with a big badge on her left breast in charge of the gurney with her assistant, a young guy obviously just learning the ropes but he seemed like a quick learner. And then there was the head paramedic who immediately engaged me in conversation. I could tell from his line of questions, he was ‘sizing me up’; did I know who I was and what was going on (I think I passed his tests). “By the way” he asked, “do you always have a low pulse rate?” I answered, “Low fifties”… They loaded me on their gurney and strapped me in; I wondered if they would be finished with me in time for me to pick Jeff and Laura up from the airport (they were scheduled to land at SNA around 4pm).

As the paramedic crew wheeled me out of the house I saw many of our new neighbors standing where they could get a good view of the happenings, and yet not be in the way (some no doubt wondering who would move into our house next); I gave them my best smile and a ‘thumbs-up’ as I was being loaded into the ambulance, a signal meant to imply that I would indeed be back and would remain their neighbor, at least for the foreseeable future. By the time we were on the freeway headed in the direction of St. Josephs Hospital, my medical team had taken all my vital signs, started an IV, scanned my heart, checked my blood-sugar and who knows what else. The leader continued with his questions most of the ride and then his body language changed, he seemed more relaxed, I could see he had come to a conclusion. I asked him to share his point of view, he was careful to let me know that the doctor would check me out and let me know his findings. Even with his disclaimer, I was encouraged by his tone of voice and relaxed posture; he mentioned a word I heard for the very first time, “vasovagal” in reference to my having passed out. What was “Vasovagal”?

Once at St. Josephs, they wheeled me in and parked me in a bed in ER room numbernine; I was feeling fine and was excited to see a wall-mounted TV (perhaps I could catch at least one of the two games I was following at home when this all started). A staff member was busy organizing my room, helping me exchange my shirts for a hospital gown while wrestling with all the wires and tubes I had so quickly accumulated. When I learned her name was “Comfort” I couldn’t help but comment on how appropriate it was that she have a name that described the product she delivered; I could tell she was a warm-hearted person. She turned on the TV to channel 7 and I was in business. From her accent, Comfort may have been from the Caribbean. We got to know each other over the next five-hours (she recommends that I switch my running for walking and she is a big proponent for yoga and described some favorite positions).

The nurse came in next, her name was Kim (I let her know that my favorite daughter was named Kim too, she quickly guessed that I only had one daughter). When asked, Kimtold me she was from West Virgina but when I asked, she didn’t know who “Zeke from Cabin Creek” was. She told me a story about how she came to know Cabin Creek but didn’t know Zeke even after I told her it was Jerry West, the greatest Laker ever! (I think she knew what a Laker was.) Kim was clearly very bright and efficient, she answered all my questions and like Comfort, her actions and approach provided comfort.

When the Doctor came in he brought Nurse Linda; she typed at the computer while the Doctor sat next to the bed and like the head paramedic had done before him started to engage me in a conversation clearly designed to both compare what he had been told had happened with what I thought had happened and to test my cognitive skills. His questions included seeking my perspective on several football games being played on thisNew Years Day. It seemed to me that the Doctor and Nurse Linda were ‘cut from the same cloth’ as Kim and Comfort; I was sure I was in good hands.

Poor Sandee, it wouldn’t have surprised me if this whole event would have caused her to have a heart attack! As she was coming down stairs, she saw her husband grab his chest and then melt into a heap on the floor. And then a team of strangers scooped him up, loaded him into an ambulance and hauled him away to the hospital.

On his way out, the Head Paramedic had told her to take her time coming to the hospital;so, she had time to work the phones. I had my phone with me and got a text from Sandee soon after I was settled into ER room number nine. It read, “I am on my way…Doug and Buffi are bringing me…Chris is picking up Jeff from airport…Sharon is coming over to watch Rocky and let Jeff in house…” It seemed she was getting the word out.

Our dear friends Doug and Buffi King were soon in ER room number nine making sure that I was okay and that I knew they cared (I assured them that I was okay and that I didknow). Soon thereafter, into the room came Sandee accompanied by my sweet mother (who was now ‘in charge’). When the Doctor next came in, mother let him know ‘how the cow ate the cabbage’. He took his directions from mother quite well; I could tell how much he appreciated her input.

This is when the Doctor officially introduced me to “Vasovagal Syncope”, the most common type of fainting. This occurs when the Vagus Nerve is triggered lowering the heart rate and blood pressure; typical triggers are 1) Prolonged standing or upright sitting, 2) Standing up very quickly 3) Stress directly related to trauma. He explained to me that the pain in my chest likely had nothing to do with my heart but was simply a muscle cramp (as I had described it) and a source of stress. He pointed out that my normally low pulse rate is good only up to the point that it becomes too low and I don’t get sufficient blood flow to my head to maintain consciousness. When I felt the pain intensify I stood up very quickly after prolonged upright sitting. As the pain continued to build (providing stress directly related to trauma), my body triggered my “Vagus Nerve” which had the effect of significantly lowering my pulse rate. So…normally low pulse rate + quickly standing up (trigger #2) + prolonged upright sitting (trigger #1) + trauma caused by unbearable pain (trigger #3) = Vagus Nerve triggered = further reduction in pulse rate =reduced blood flow to head = loss of consciousness.

To prove his theory, the Doctor ordered immediate blood work to check for troponin levels (chemicals released into the blood by damaged heart muscles) I suppose to establish a base line. He had me hang around for another three-hours so he could test my blood for any changes in the troponin levels (so I was able to watch most of the Rose Bowl Game). He also had a tech named David create a pretty long movie of my heart in action via ultra-sound to go along with the two EKGs; one produced by a different Davidwhen I first arrived and the other produced by Gus near the end of my stay. Once, he had all of the above to review, he cleared me for a full-on Stress-Test.

That’s when I met the Cardiologist. He explained the stress test rules; he would wire me up, I would walk on a treadmill while he monitored my heart. Every three minutes the incline of the treadmill would be increased along with the speed of the belt I was to walk on. He asked me to let him know when I wanted to quit. That’s where we had a problem. I had gotten to know him well enough to let him know that I wasn’t planning on quitting, ever. He could let me know when he had seen enough and then we could stop. We agreed to disagree and started the test anyway. That was the best workout I’ve had in a long time; we finally negotiated the termination of the test on mutually satisfactory terms.

I left the hospital that day having met some great new friends, I got an incredible workout and was assured by some of the best that my heart and for that matter my general health were both quite sound. I didn’t die that day from a heart attack, but some day I might. I did think about death as did some of my family members and close friends. It’s all good.

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