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A 29 year old man was admitted because of a single episode of syncope. He was previously healthy with no record of cardiovascular symptoms. He regularly engaged in different kinds of strenuous sporting activities including spinning. Spinning is a special setting of indoor cycling in a group, often led by an instructor. The music that accompanies the spinning is to push the cyclists to higher levels of performance. Usually people wear a heart rate monitor in form of a pulse wrist watch. After about 30 minutes of cycling the young man suddenly became unconscious. He regained consciousness after a minute and was brought to the emergency department of the nearest hospital. On admission the patient’s physical status, ECG, and laboratory findings were unremarkable. However, the printout of the pulse watch (Polar 720) (panel A) showed not only the constant increase of the heart rate from around 90 beats/min to around 170 beats/min, but a sudden increase to around 225 beats/min when the patient became unconscious. This finding prompted admission of the patient to the hospital for further work up. An electrophysiologic study revealed the easy and reproducible induction of monomorphic ventricular tachycardia (VT). Coronary angiography revealed unexpected severe three vessel coronary artery disease (panel B). The patient underwent coronary bypass graft surgery. Subsequent electrophysiologic study revealed the same VT induction, prompting the implantation of an implantable cardioverter-defibrillator.
It is very possible that without the findings from the pulse watch, the work up of this young man’s syncope would have been less straightforward, and would not have uncovered the mechanism of the syncope—VT—or the underlying coronary artery disease. The critical information provided by the pulse watch may well have saved the patient’s life.