Patient Profile 46 year-old male 6’5” (197cm) - 225lbs (102kg)
active lifestyle, non-smoker, non-drinker, vegan diet Vitals
Heart-rate: 130 w/arrhythmia
Blood pressure: 160/120
Symptoms
Tightness/pain in chest, difficulty breathing, numbness/pain radiating down left arm
EKG and IV required immediately
{This is where our narrative flashes back a few days}
Nelly and I deliberately blocked out the entire month of June for ourselves ages ago. It’s been a busy few months and we figured on having a week off, then going to Mexico City for a while, then having a week of vacation at XOC-Ha ourselves before getting back to work. We’d been looking forward to it for ages and it was finally here.
My first day off I wasn’t feeling terribly well. I’d spent the last week and a half doing some wonderfully fun, but super-long dives and I figured thermal stress had finally gotten on top of me, so I’d lounged around, relaxing and napping most of the day.
Felt OK the next day… when we randomly lost power. So Nelly and I were hustling around, getting the generator up and running, running power cords and whatnot.
When, suddenly, my heart rate went through the roof. I’d been arguing with the generator a bit, and it was a hot day, so I wasn’t surprised. What was surprising was just how high it went. I couldn’t think, I couldn’t breathe, I was pouring sweat.
I jumped into the pool to try to cool down, where I hung on to the side and gasped for a few minutes. (NOTE: In retrospect… not a great idea. Sudden vasoconstriction causes blood-pressure to skyrocket.)
Recovering my wits I went inside for a lay down. Luckily, the power came back within about two hours and I savoured the AC. But my pulse wouldn’t quite recover, staying between 100-120.
… for the next two days.
I chalked it up to long-COVID and lay around watching movies or binging this or that series people have been telling me “You should watch.” Kept thinking to myself, “So I’m a little uncomfortable, but at least it’s a good excuse to watch nonsense I wouldn’t otherwise.”
Late Friday night that changed. I started to wonder if I was imagining numbness in my left arm.
A hypochondriac by nature, I tried to put it out of my mind. Because, of course, if I started worrying that I was having a heart attack, it was going to make my already growing discomfort even worse.
I tried to calm myself by watching dumber and dumber shit (The series Legion, if you’re interested… it’s actually pretty good). But my mind kept wandering back to, “Are you dying?” which is a disconcerting feeling indeed. “What if I’m not even dying, but I need open heart surgery or something? We won’t be able to go to Mexico City! I won’t be able to work again until who knows when!”
I could feel the extremely elevated blood pressure throughout my body. I thought about going out to the car to get my blood pressure cuff and stethoscope out of the first aid kit… but worried about the repercussions of such an adventure.
Usually (and this is important) my blood pressure is very low, almost extremely low. I’ve had nurses go, “Whoa!” when taking my BP. Usual for me: 90/60 or so.
But now I could feel the pressure throbbing in my carotid against my fingers as I was compulsively taking my pulse. Even more alarming, I could feel a consistently random palpitation. Odd, long pauses between heartbeats, as if my heart had to stop for a breather itself from time to time.
“You’re just freaking yourself out more and more,” I kept telling myself, “Breathe, watch the show, relax. It’s not a heart-attack dipshit; you are so far outside the demographic for heart-attack you can’t even see it from here. You’re giving yourself a panic attack."
Denial is a dangerously strong impulse. No matter how many hundreds of times I have taught about medical emergencies in CPR courses or rescue diver courses or whatever others where it comes up that one of the first symptoms of heart attack/DCS is denial. There I was, trying to rationalise away my symptoms.
But it was growing close to dawn and, rising with the sun, so rose the awful realisation that the numbness in my arm I had thought I was imagining… it was not imaginary. From shoulder to mid-forearm actually ached. My chest hurt. I couldn’t breath properly. If I tried to stand up my head would swim. Denial, I finally admitted, was foolish as a motherfucker.
“Nelly.”
“Hmmm,” she answered blearily.
“We have to go to the hospital.”
Her eyes snapped open at those words.
The hospital sucked. I mean, the hospital was fine; everyone was attentive, helpful, the place was nice… it was just a sucky situation, wasn’t it?
We were there for hours. An IV in my arm. Swallowing medication after medication to get everything in my chest to cooperate again. Which it all finally did, sorta. Still on the high end of safe, but safe nonetheless.
Until the doctors explained that the next step was to load me onto an ambulance to their other branch. There, a cardiologist was going to look at me “And,” he explained, “You will probably need a cardiopulmonary endoscopy. So we’re going to need a thirty thousand peso deposit.”
(NOTE: I do not, in any way, suggest not following the direction of a medical professional, especially during a medical emergency. However…)
I’m a cynic, if you haven’t figured that out by now. And I was sitting in a for-profit hospital. Who were recommending that I get a very expensive, very invasive procedure done. And quite a lot of testing. Requiring at least two-nights’ stay in their facility. After a very expensive mandatory ambulance ride. Despite the fact that I was now perfectly stabilised.
I signed voluntary release papers and Nelly brought me home.
Under Nelly’s strict orders I barely moved a muscle for the next day and a half, while she made an appointment with a cardiologist highly recommended by one of our neighbours.
“Did you feel a little dizzy, just then, when you sat up?” he asked after examining me.
I told him that I almost always feel dizzy when I sit or stand up because my blood pressure is usually so low.
“That’s what I thought and why I asked,” He said, settling behind his desk, “I think you’re fine. Nothing looks terribly abnormal about the EKG they took or any of the blood tests they ran. You definitely don’t need an endoscopy. I’ll tell you what I’m pretty sure happened to you.”
It’s now summer in the Yucatan. Which means it’s getting hot. And, like an idiot, I’m one of those people who is carrying around heavy-ass dive gear in the jungle, up and down stairs, or up and down pulleys. Then I go on to put on thick undergarments and zip myself into an air-tight bag.
So I sweat.
And in sweating I lose electrolytes. Lots of them.
The only thing I’ve ever really known about electrolytes is that they’re what plants crave. And that there’s a drink that’s everywhere around here called Electrolit which I like the taste of and find really refreshing. But I’ve stopped drinking it recently because I’m trying to cut down on sugars in my diet.
And that was the mistake.
Turns out when you lose electrolytes, cumulatively day after day after day, your blood pressure drops.
If your blood pressure is already low, and it drops beneath a certain threshold, your body, in an effort to make up blood pressure, will increase your heart rate.
And if your blood pressure remains lower than what your body wants… you wind up in a negative feedback loop, where everything your body tries to do to fix the problem just keeps making the problem worse. Which can escalate and escalate, tachycardia and high blood pressure playing off of each other, to where it feels like…
… you’re having a heart attack. Complete with all the symptoms.
“So what you’re going to need to do is, have you seen a drink called Electrolit?” He literally wrote on a prescription sheet that I should drink two, slowly, each day but definitely every work day. Coconut water (which I also love) is a good natural substitute.
He recommended a stress test as well, just to be sure. That was this morning. Confirming my heart is, indeed, vegan-level healthy.
So… I had a scary-ass week. But all’s well that ends well and whatnot.
I got to face mortality down and win. I learned what an electrolyte is. I had my grizzled cynicism about predatory capitalism confirmed (fuck that hospital). I got to watch all of Legion. And I got as thorough a physical as exists.
Best of all, now I get to pass my fears and suffering on to others.
A - In the form of this rambling recount of the affair
B - As I demand of everyone I ever guide or teach in the future they hydrate and electrolyte the hell up even more than I have in the past. So that they don’t wind up laying in one of our guest houses, up all night, wondering whether they’re dying, too afraid that if they admit it’s an emergency they’d actually make it one. When the problem could have been solved by a coconut.
Right. Now that’s done and I’ve got a clean bill of health… I’m going to pack for CDMX.