The doctor wasn't sure what to think when he saw the woman hanging upside down, a tall man holding her by the ankles, outside the emergency room.
The doctor was Louis F. Janeira, MD, a cardiac electrophysiologist in Terre Haute, Ind., and the woman, in her mid-60s, was a patient he had seen the day before.
Dr. Janeira recounts the case in the July-August issue of Discover magazine. To keep the woman's identity private, he calls her Mary.
Mary (not pictured here) had received an implanted pacemaker at Dr. Janeira's recommendation shortly after presenting in the ER with a slow heartbeat, which was causing fainting and seizures. Pacemakers use electrical pulses to speed up or slow down an irregular heartbeat. They are implanted under the skin of the chest wall during minor surgery.
The next day at home, Mary collapsed after a coughing fit. She and her husband, whom Janeira calls Jason in his article, figured out that the only thing that kept Mary from fainting was hanging upside down. That's how the pair ended up back at the hospital before a puzzled Janeira.
Janeira racked his brain for an explanation. He and a nurse checked Mary's vitals. Her blood pressure and the pacemaker's function looked normal — but only while she was upside down. When they tried laying her right side up, the pacemaker failed and Mary lost consciousness.
Then Janeira realized what it could be. Perhaps, during Mary's coughing fit, the wire going from the pacemaker to the heart had disconnected. He wasn't sure why, but somehow the wire seemed to reconnect (and work) when Mary was upside down.
"Pacemakers are made up of two main components, a generator and a lead that carries electrical impulses to the heart," Janeira writes in Discover. "Often the lead tip is screwed directly into the heart muscle, but in rare cases it can dislodge and cease to stimulate the heart."
Janeira sent Mary back to the operating room, carried upside-down, he writes, to have the pacemaker repaired. The next day she walked out of the hospital feeling normal again.
In his article, Janeira cites data from pacemaker manufacturer St. Jude Medical, which show that "out of about 220,000 implants of the company's most popular lead attached directly to the heart, only 97 dislodged within 30 days of implantation."
It's unlikely that what happened to Mary will happen to you or a friend or relative living with a pacemaker, but, besides getting to a hospital STAT, at least you now know something to try in the event your pacemaker isn't working.
Last Updated: 9/5/2012