Ep. 47 | The Tell-Tale Heartbeat
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On a cold, rainy Sunday night in early 2022, a middle-aged woman lay on her back on a patch of grass in Seattle, Washington's Lake Union Park. Her limbs were splayed out at crooked angles and her workout clothes were soaking wet.

She appeared to be barely breathing. But then her eyes blinked open. For a moment, she couldn't tell where she was. She had no idea how long she'd been laying on the ground, either. The last thing she remembered was glancing out at all the lights on the boats as she jogged along the waterfront. Then her vision had gone cloudy and she became very dizzy. She'd stumbled toward a bench to sit down, and then everything went black.

Still lying on her back, the woman craned her neck to look around the park for someone to help her, but it was totally empty, like she was the only person in the entire city. If she hadn't woken up on her own, she wondered how long it would have been until someone found her.

Then, she noticed a group of rabbits staring at her as they munched on a nearby patch of grass. She knew it was totally ridiculous, but for just a moment, she hoped these bunnies would hop over to her and rescue her. But when that didn't happen, she rolled onto her stomach and slowly stood up on her very unsteady legs. It was going to be a mile-long walk in the pouring rain back to the houseboat where she lived, and the whole way, one thought kept pounding in her mind.

Why was this happening again?

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So if you liked today's story, please offer to house sit while the follow button is on vacation, but once they leave, just go ahead and invite 10-15 wild emus into their house and then leave. This episode is called "The Telltale Heartbeat." On a cool fall morning in October of 2000, 27-year-old Maureen Ryan was out for her daily jog. The air felt crisp in her lungs as she kept a brisk pace along the waters of Cape Cod in Massachusetts.

Until recently, she had been working as a rock climbing instructor out west, so as a result, Maureen was in great shape and very fit. She had always been athletic though, rowing crew and playing lacrosse and field hockey back during her high school days in Pittsburgh. But today, halfway through her very routine run, she suddenly felt woozy and a surge of nausea crept up from her stomach.

Maureen slowed to a walk and tried some rhythmic breathing to try to steady her heart rate. Unfortunately, it didn't help. She got dizzier and more lightheaded until it felt like the ground was tilting, and then suddenly it was rushing up at her. The next time she opened her eyes, Maureen was face down on the jogging path, her cheek pressed flat against the cold concrete. Her head absolutely throbbed. She rolled onto her side and began rubbing the bruise on her skull.

Maureen felt lucky she hadn't knocked any teeth out when she fell, but at the same time, Maureen just could not understand how her body had just abruptly shut down like that. She had only fainted one other time in her life, and it was back in college, after she had gone on an unusually fast treadmill run. Maureen assumed it was just a fluke because it never happened again.

But now she wasn't so sure, because just the week before during another run, she had felt at one point sort of hazy and actually stopped to rest, but that was obviously nothing compared to today where she actually fell to the ground. And if this had happened while she was on stairs or something, she could have been seriously injured.

And so suddenly Maureen was terrified. It was like she couldn't trust her body anymore despite having spent so many years working so hard to become strong and healthy and fit. It was like it didn't matter. Her body was going to do whatever it was going to do. Maureen picked herself up and carefully made her way home and when she got there, she called her aunt Eileen who was a doctor in Pittsburgh. Eileen was a pathologist who ran lab tests on tissue, fluids, and organs in order to diagnose diseases, especially heart disease.

But she was knowledgeable about most health issues, so Maureen really wanted her opinion on what had just happened to her.

Eileen thought for a moment after Maureen told her about how she had just fainted during her run. Then Eileen told Maureen that she might be experiencing some type of irregular heartbeat. If left untreated, Maureen's aunt said that an irregular heartbeat could cause that lightheadedness and fainting that Maureen experienced. But realistically, that was the most mild of symptoms. This irregular heartbeat could lead to permanent damage to her heart, her brain, and other organs.

It could even cause strokes, heart failure, and even death. And so Eileen urged Maureen to stop doing any serious exercise until she could meet with a doctor.

Maureen appreciated her aunt's advice, but it was hard to accept. Being physically active and pushing her body to its limits made her feel energized, joyful, and alive. To stop exercising cold turkey would be a real challenge for her, but at the same time, she didn't want to risk fainting again, so she promised her aunt that she would take a break from running and would see a doctor as soon as possible.

A few days later, Maureen lay on an examination table wearing a hospital gown. She flinched at the feeling of cold metal as the cardiologist stuck a series of electrodes to her chest. Even so, she was still glad to be there. She had not gone for a run since she talked to her aunt, and she was eager for this to be over with. Once the electrodes were in place, the doctor made sure the cables running to the EKG machine were untangled and connected properly.

These would convert electrical signals from Maureen's heart into waves displayed on the EKG grid. By studying these lines, the cardiologist would be able to identify any irregularities in Maureen's heart's activity. Maureen closed her eyes and listened as the doctor flicked a switch. The machinery hummed into action and soon Maureen could hear the beeps corresponding to her heartbeat. Five minutes later, the test was over and so Maureen opened up her eyes.

The cardiologist quickly pulled up the results on a large computer monitor. His face was neutral as he scrolled through the data, occasionally stopping just to jot something down on a pad of paper. Finally, the doctor scooted his chair back, set down his pen, and turned to face Maureen. He told her he knew why she had been fainting.

She had a condition called Wolff-Parkinson-White syndrome. It's a congenital heart defect that makes the heart beat faster than it should, sometimes causing dizziness and fainting. Maureen was relieved to have a name now for what she'd been experiencing, but she was also shaken at the thought that there was something fundamentally wrong with her heart. The doctor could see how worried Maureen was.

And so he told her the good news was that this condition was totally treatable using a procedure called a catheter ablation. It's a surgery where thin, flexible tubes are guided into areas of the heart suspected of causing the irregular heartbeat. Then once it's in place, the surgeon permanently changes the electrical circuitry of the heart by creating scar tissue in these problem areas. Scar tissue does not conduct electricity, so once that's done, the irregular heartbeat disappears and

and the heart returns to normal. Maureen thought this procedure sounded really intense and pretty complicated, but she was at least happy to have, you know, the next steps in place. So she thanked the cardiologist and said she would schedule this procedure as soon as possible. Back at home, Maureen called her doctor aunt with the news, and Eileen suggested that Maureen have the catheter ablation done in Pittsburgh where she was so Eileen could look after her after the procedure was done. Maureen agreed, thanked her aunt, and hung up.

Then Maureen went for a long walk along the bay, letting her mind wander. She hoped the sea breeze and the lapping waves might calm her nerves, but she was too distracted. All she could hear was the sound of her heartbeat in every footstep. Two weeks later, Maureen stood outside a hospital in Pittsburgh with her aunt Eileen. Maureen had barely slept the night before, worrying about this catheter ablation, you know, what could go wrong? But eventually, they went inside the hospital, and they went up to the receptionist's desk, and they signed in.

Once Maureen's name was called, she hugged her aunt goodbye and she followed a nurse down the hall to get prepped for the operation. As Maureen settled onto a gurney, the nurse explained that the procedure would take about 3-6 hours, but Maureen would be sedated the entire time and wouldn't feel a thing and would just kind of wake up when it was done. Then the nurse had Maureen lie back and she inserted an IV drip into her forearm.

Seconds later, Maureen started to feel the warm and dreamy sensation as the sedatives hit, and soon her eyelids were too heavy to keep open, and she drifted off to sleep.

Several hours later, as Maureen drifted back to consciousness, she stared up at the lights on the ceiling. It took her a minute to realize where she was, in a recovery room at the hospital. But once she understood where she was, she noticed her doctor was right there looking down at her. And once the doctor saw she was awake, he told her that the procedure was a total success.

He said they had been able to find the section of Maureen's heart that was causing the irregularity, and they covered it with scar tissue. The doctor advised Maureen to schedule occasional follow-up EKG tests just to make sure her heartbeat remained steady, but otherwise she was good to go. She could go back to her normal life. Maureen could not contain her smile. This was everything she had hoped for, and she could not wait to get back on her feet and go for a run.

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Two decades later, in October of 2022, Maureen sat on her bed shivering and dripping wet, holding a phone to her ear and wishing her Aunt Eileen was with her again. She had just made it back to her Seattle houseboat after fainting during that run in Lake Union Park.

One moment she was jogging along happily, the next she was unconscious on the ground in the pouring rain staring at a bunch of rabbits. It felt like her past heart issues were coming back to haunt her. But Maureen just couldn't understand how that would have happened. The catheter ablation operation she did back in 2000 was supposed to have fixed everything. And she had been exercising and living her life normally for years now without any major problems.

But now here she was again, two decades later, nauseous and dizzy and passing out on the ground. After waiting a while on hold, Maureen was finally connected to a doctor who was inside of her healthcare plan. She told him about fainting in the park and summarized her fairly extensive medical history. The doctor told her to come in the next day for an EKG and also some blood tests. After she hung up, Maureen just sat there staring at the rain landing on the water.

She thought she was done dealing with her body's mysteries, but clearly something else was wrong. The next morning, Maureen woke up early, still feeling rattled.

She filled a thermos with coffee, put on a raincoat, and headed to her appointment. Once at the hospital, Maureen explained to the cardiologist how her career as a conservation biologist kept her extremely physically active. Even outside of her work, exercise was her favorite activity. In addition to jogging, Maureen skied, she swam, and went mountain biking. Occasionally, she would still experience a bit of dizziness or nausea,

But it passed quickly, and every doctor she'd seen in the 22 years since her catheter ablation always told Maureen the same thing. Her vital signs were right where they should be. The cardiologist nodded and took some notes. Then he had Maureen lie back and arranged a series of electrodes on her chest for another EKG. Maureen took a deep breath, closed her eyes, and focused on the soothing hum of the machine as it measured her heartbeat.

After a few minutes, the cardiologist pushed back his chair from the computer and came to Maureen's side and helped her sit up. Maureen braced herself for bad news from this test, but the cardiologist only shrugged, shook his head, and told Maureen that her results were normal. Nothing looked out of the ordinary.

Maureen felt lost and frustrated. She knew the test had to be wrong because she was positive something wasn't right in her body. Last night in the park, she genuinely thought she was going to die. So how could this EKG test show nothing? It made no sense. The cardiologist told Maureen to call if she experienced the symptoms again, but until then, there really wasn't anything he or the hospital could do.

Maureen thanked the doctor and appreciated what he was doing, but she knew now it was up to her to do some research of her own. Back at her houseboat, Maureen sat on the deck with a cup of coffee, a stack of books, and a printed copy of her test results. She'd stop by the library on the way home to check out a few books on heart conditions. Maureen's career as a conservation biologist had trained her to identify patterns in complex data, so studying EKG results did not seem overwhelming to her.

The chart showed the electrical energy of her heartbeat on a graph. Each heartbeat looked like a spike as the blood is pushed out with a little hiccup before and after it. She could see exactly how much electrical energy was being transmitted each time her heart beat and exactly how long each beat lasted. After looking at these charts for a while, Maureen noticed an irregularity in her heartbeat that the doctor had not mentioned.

The amount of time from when her heartbeat spiked to when her heart was ready for the next beat seemed to vary from beat to beat. Sometimes it was very short and other times it was much longer. This worried Maureen because she knew the heart is supposed to beat very evenly. So she grabbed the phone and called her aunt Eileen.

Her aunt recognized it immediately as a heart condition that can cause fast, unpredictable heartbeats. It's called Long QT Syndrome, and it's very tricky to diagnose because most patients actually show no symptoms. But for those that do, the most common symptoms are lightheadedness, blurred vision, and fainting, just like Maureen had.

Eileen recommended a doctor in Seattle who specialized in heart disorders. If Maureen did have Long QT Syndrome, he'd be able to confirm it. Maureen thanked her aunt for all her help and said she would call back once she had news. On a cold and gray winter morning the following month, Maureen was back at the hospital in Seattle, this time carrying a bag containing her workout clothes and running shoes. She followed a nurse into the cardiology wing, then into a changing room where she put on her workout clothes.

A few minutes later, a man knocked and introduced himself as the doctor that Maureen's aunt had recommended. He led Maureen down the hallway to a larger room with a treadmill right in the middle. The doctor then hooked pulse monitors to Maureen's wrist and forearms, and he explained that he'd be monitoring her heartbeat and blood pressure while she ran on the treadmill. That way, he could determine what was changing inside her body during vigorous exercise. Maureen did some stretching and then began a brisk walk as the doctor slowly accelerated the treadmill.

Soon, Maureen was sweating, huffing, and running at full speed. And all the while, the doctor just kept his eyes on his screen. And after running for a little bit, Maureen suddenly felt a very familiar sensation. Her peripheral vision turned foggy, her head felt woozy, and then before she could do anything, she was falling face-first onto the rubber mat of the treadmill.

When Maureen blinked back to consciousness, she looked up and saw this big group of men and women wearing hospital scrubs crouch down around her. One of them reached down and helped scoop her up into a sitting position. And as they did that, Maureen realized this was an emergency resuscitation team that had been called in when she fainted to resuscitate her. The doctor who had been overseeing the running test came over and crouched down by Maureen's side.

He explained that her blood pressure and heart rate had plummeted when she was running and then she passed out. It happened too fast for anyone to catch her. But the doctor told her that this test had actually been really useful because the results showed her issue wasn't a problem with her heart. It was more likely a complicated fainting condition sometimes seen in athletes. For Maureen, intense exercise was short-circuiting the nerve endings that regulated her heartbeat.

This caused her blood pressure to drop, which in turn slowed the flow of blood to her brain. This is what made her feel lightheaded and dizzy to the point of fainting.

Maureen, who was still sitting on the treadmill, was dazed by the diagnosis. Every doctor she had seen for the past 20 years had told her there was something wrong with her heart, that that was the issue. But now it sounded like the problem was actually in her brain. Maureen asked the doctor, you know, what do I do? How do I keep myself from fainting? The doctor smiled and told Maureen she was actually in luck.

To get around the nerve issues and stabilize her blood pressure, all she would need to do was consume 1.5 teaspoons of ordinary table salt every day. Now, that's more salt than most people consume on a daily basis, but it was just enough above the normal amount that it would raise her blood pressure to the point where she would not faint the next time she did strenuous exercise.

This sounded almost too easy to Maureen, but at the same time, she was grateful that she had a cure. She got to her feet, thanked everyone, and then went to go buy some salt. But a month later, on a cloudy, rainy Seattle afternoon, Maureen, who was very frustrated, stepped out onto the deck of her houseboat and dumped her salt into the water. She was totally done with this cure. Daily doses of salt had done nothing.

For weeks, Maureen had been dissolving salt in a tall glass of warm water and forcing herself to drink it. At first, she held out hope that she might eventually start to see some changes, but she never did.

Consuming all this salt had only made her bloated and anxious. It did nothing for her heart. Even on light jogs, Maureen's chest would feel tight, her stomach would turn queasy, and she'd be out of breath like she was about to faint. So whatever was wrong with her heart was definitely still wrong, and the salt was doing nothing to fix it. Frustrated, Maureen again called her Aunt Eileen for advice for what felt like the millionth time.

This time, Aileen recommended that Maureen reach out to a very specific physician named Dr. Samir Saba, who specialized in a very special kind of MRI scan that identifies diseases and defects in the heart. Despite the diagnosis Maureen had received, Aileen still thought there really could be issues with her heart. And so this special MRI test, which gives very detailed pictures of the heart, might actually finally answer what was going on with Maureen.

Now, Maureen was skeptical that anybody could figure out her mysterious condition after so many other doctors had tried and failed, but she had nowhere else to turn. And so Maureen asked her aunt to go ahead and book her one of these special MRI scans with Dr. Saba. And while she did that, Maureen would buy a flight to Pittsburgh. A week later, Maureen sat nervously in the front passenger seat as her aunt Eileen drove to the University of Pittsburgh Medical Center.

Maureen watched out the window as a soft drizzle fell across the city, the same damp gray weather she was used to back in Seattle. She looked forward to being back on her cozy houseboat, but before she could go home, she still had this one last test she had to take. Maureen shuddered at the sight of yet another hospital as they got out and began walking towards the building.

Once they went inside, Maureen followed a nurse through several sets of double doors into a white-walled, brightly lit MRI room. The nurse helped Maureen get undressed while she explained the procedure. A magnetic resonance image can create 3D images of the organs and tissues inside of a person's body. These detailed images allow doctors to find heart damage without needing to perform surgery on the patient. Maureen climbed up onto the stark white table and laid down flat.

She heard a machine whir, then the table with her on it slid inside a narrow tube. At first it felt claustrophobic, but Maureen shut her eyes and just pictured herself going for a run and it put her at ease. Maureen lay there listening to the sounds of the imaging machine and then after about an hour the noises stopped and she, on her gurney, was slid back out from the tube.

Maureen sat up feeling strangely relaxed. Dr. Saba was there waiting for her and he told her it would take a couple of weeks to get the results back, but he would call her as soon as he could. Two weeks later, Maureen was back on her houseboat in Seattle, Washington when her phone rang. The caller ID said University of Pittsburgh Medical Center. Bracing herself for more frustrations or worse, Maureen answered and heard Dr. Saba's voice on the line. He told her he had some absolutely wild news.

The issue with Maureen's heart was something that none of her previous doctors had thought of. Not only that, but it was something Maureen had lived with her entire life. The problem with Maureen's heart had nothing to do with its beat or nerve endings or scar tissue or any of the other things doctors had talked about for all these years. Instead, Maureen's heart was the wrong shape.

The major artery carrying the blood from Maureen's heart to her body was literally in the wrong place, and so her unusual anatomy was causing Maureen's blackouts, not all the other rare conditions that doctors had thought previously. Maureen's right coronary artery was squished underneath another large blood vessel so that it was slightly constricted. When Maureen went about her normal activities, there wasn't any issues.

But when Maureen exercised, her heart had to beat faster and pump more and more blood to keep up. But since her artery was in the wrong place and compressed, eventually it couldn't hold enough blood to meet the needs of the heart. This caused Maureen to faint. And no doctor would ever think to suspect this as the cause, because less than 1% of the entire population has a structural defect like this one.

But the dangers of this rare condition are extremely real. Dr. Saba told Maureen that her collapse in the park was more likely a heart attack and if it had lasted much longer, she would have died.

Maureen was speechless. Across 20-plus years of seeing doctors throughout the country, no one had ever mentioned even the existence of a condition like this. She'd been living with a misshapen heart since she was born, and without Dr. Saba, it's very possible she would have never found out and likely died from it.

Later that summer, Maureen underwent a three-hour-long open-heart surgery at the University of Washington Medical Center in Seattle, in which surgeons successfully moved her right coronary artery, the one that was in the wrong spot, over to its proper location. Maureen still has lingering chest tightness and fatigue, but the operation allowed her to go back to her physically active life without fear.

Gradually, she was able to start fully exercising again, and though her speed is not what it once was, Maureen has never fainted since. Hey Prime members, you can listen to new episodes of Mr. Ballin's Medical Mysteries early and ad-free on Amazon Music. Download the app today. And also, Wondery Plus subscribers can listen to Mr. Ballin's Medical Mysteries ad-free. Join Wondery Plus today. Before you go, tell us about yourself by completing a short survey at listenersurvey.com.

From Ballin Studios and Wondery, this is Mr. Ballin's Medical Mysteries, hosted by me, Mr. Ballin.

A quick note about our stories: we use aliases sometimes because we don't know the names of the real people in the story. And also, in most cases, we can't know exactly what was said, but everything is based on a lot of research. And a reminder: the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This episode was written by Britt Brown.

For Ballin Studios, our head of production is Zach Levitt.

Script editing is by Scott Allen and Evan Allen. Our coordinating producer is Matub Zare. Executive producers are myself, Mr. Ballin, and Nick Witters. For Wondery, our head of sound is Marcelino Villapando. Senior producers are Laura Donna Palavoda and Dave Schilling. Senior managing producer is Ryan Lohr. Our executive producers are Aaron O'Flaherty and Marshall Louis for Wondery.

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