The day was sweltering. The 61-year-old woman urged her donkey into a trot. She loved riding around the ring on the beautiful white beast — at a walk, then a trot, then a canter. Suddenly she noticed a tingling in her hands and feet spreading toward her torso. She recognized the sensation but willed herself to ignore it. It didn’t work. Her strength seemed to melt away, and before she could say or do anything, she felt herself slumping forward. As the world turned gray, the donkey stopped. Her arms, and then her body, slid down the animal’s sweaty neck and onto the ground. Then everything went black.
She woke up looking at her donkey’s snow-white belly. He leaned down and nickered softly, then brayed at the approaching instructor. Are you OK? The instructor called out in alarm. Should I call an ambulance? She was fine, the woman assured the instructor. It was just that hot weather could really get to her. She allowed herself to be helped over to the cool darkness of the barn. As she lay on the damp concrete floor, warm tears made their way down her face. I can’t keep going like this, she thought.
She first fainted maybe four years earlier. She was at the gym, finishing up a brisk walk on the treadmill, when she felt the odd tingling. Black dots swam in front of her eyes, and she heard the thump of her head hitting the wall of windows in front of her. Then the black took over. She awakened surrounded by worried faces. It was strange — she was an active person. Her job as a field geologist kept her hiking and climbing regularly.
She went to her primary care provider, a nurse practitioner. She had high blood pressure, the N.P. said, but was otherwise healthy. The woman was sent to a local cardiologist. Yes, she told that doctor, she did get out of breath more easily than she used to. And yes, sometimes she did get more tired than she expected. But no, she never had chest pain or pressure. Mostly she felt fine. And she didn’t faint often: a few times a year, mostly in the summer when she was exerting herself in the heat. She had an exercise stress test and, when that was normal, a scan in which a radioactive dye outlined how effectively her heart was beating. It was also normal. So was an echocardiogram.
So the woman’s N.P. focused on her blood pressure and improvements to her diet. But even when her blood pressure seemed to be perfect, every now and then she would find herself on the ground looking up at concerned faces.
A Hard Look at Her Heart
It was after the fall from the donkey that the woman decided she needed a new set of eyes on her problem. She made an appointment with Dr. David Ramos, a cardiologist at a Columbia New York-Presbyterian office in Monroe, N.Y., near her home in the village of Piermont. It took months to get in. But when she finally met Ramos, he listened thoughtfully as she described her worsening sense of being out of breath, her increasing fatigue during even mild exertion, the repeated blacking out. An exam was unremarkable. Ramos reviewed her records. Fainting, known medically as syncope, is a common enough problem caused by diminished blood flow to the brain. Forty percent of us will faint at least once in our lives. And for most of us, it will be only once, triggered by a sudden change in either blood pressure or heart rate, often in reaction to a medication or some type of emotional or physical stress.
