When her heart rate didn’t come down, Courtney Moskowitz had to seek help.
By Melissa F. Pheterson
Courtney Moskowitz is the sort of fitness fanatic who doesn’t shy away from a heart-pounding workout. On May 29, when most people were kicking back for Memorial Day, the 42-year-old fitness trainer kicked it up instead — heading to CrossFit Mount Kisco with her fiancé, Harry. Tackling a workout that entailed pull-ups, push-ups and squats sandwiched between two mile-long runs, Moskowitz says, “The last 400 meters, I’m pushing myself hardcore. I see my coach and friends screaming, ‘Come on, Court!’” She summoned one final burst of energy, to finish strong at 48:24, a personal best from years before. Then, she gulped a few breaths of fresh air, walked around the gym and waited for her heart rate to come down.
After three minutes, she recalls, her heart was still racing; her chest got tight and was beginning to ache. “I put my fingers on my neck artery, to check my heart rate, and it’s not going down; actually, it’s going up,” she recalls. “I thought: What is going on here?” She willed herself to stay calm, to keep walking and breathing, and to take pictures to post on Facebook in triumph. But her smile broke as she told Harry, a pediatrician, what was wrong.
“I told him: ‘I don’t feel good. I have pain in my chest, and I feel like I’m having a heart attack.’ He said, ‘Sit down; calm down. We checked my heart rate, and it was flying. I came to a point where I couldn’t breathe; I couldn’t talk. I took my finger and traced the numbers ‘9-1-1.’” Harry then realized that she was having a cardiac episode.
Racing into the gym some minutes later, the first responder connected Moskowitz with an EKG and watched it spit out a report of first 190, then 220, beats per minute — and climbing. Suspecting the issue was a heart arrhythmia that caused rapid, heartbeats, the EMT gave her an emergency injection to break the episode.
“It felt like an entire building was collapsing on top of me,” she says.
Moskowitz was referred to Sei Iwai, MD, Director of Cardiac Electrophysiology at Westchester Medical Center, the flagship of the Westchester Medical Center Health Network (WMCHealth). After studying the printouts of Courtney’s spiked heartbeat during her episode, Dr. Iwai also discovered that Moskowitz had been diagnosed with an anxiety disorder in her 20s, marked by rapid heartbeats for no reason. He surmised that Moskowitz’s prior issue may not have been anxiety, after all: It could all be explained by a condition called supraventricular tachycardia, or SVT, that caused rapid heartbeats.
“The strenuous workout unmasked the typical symptoms of SVT: accelerated heart rate, palpitations, dizziness, chest tightness and throat fullness,” he says. “ is is an electrical issue, not a heart attack. It can often affect completely normal hearts and very active people.”
Dr. Iwai reviewed the options with Moskowitz: watching and waiting; treating with medication; or performing an ablation procedure that uses heat to cauterize and destroy haywire electrical signals in cardiac tissue that precipitate episodes like the ones Moskowitz was having, yet leave the rest of the heart intact.
Because Moskowitz’s profession and passion was CrossFit training, and because she was getting married in Hawaii the following month, the solution was a no-brainer.
“The medications we’d typically give would lower Courtney’s heart rate and exercise tolerance, so she would have gotten tired more quickly,” Dr. Iwai says. “She was a good candidate for ablation. In the last decade, catheter ablation has become the first-line therapy for SVT because of the high rate of success and the low complication rate.” He told Moskowitz that he could do better than manage her condition; he could cure it completely.
Still, Moskowitz wavered and asked if it was really necessary. As she tells it: “He said, ‘You’re healthy, fit and young, but when an episode like this happens, it’s probably going to happen again. Your heart has a bad pathway. This is a serious issue.’”
On June 16, Moskowitz checked into Westchester Medical Center for the same-day procedure. “I’d never even had a cavity,” she says. “Plus, I was planning my wedding. I was freaking out.”
Trough the veins in the groin, Dr. Iwai was able to slip a thin catheter with electrodes into Moskowitz’s heart. “We gather electrical information from the inside, much as an EKG does from the outside,” he says. “We stimulate different locations, trying different speeds and patterns to get into the circuits and induce the arrhythmia.” Once he did, Dr. Iwai could confirm that Moskowitz had the most common type of SVT: AV nodal reentry, a redundant connection between the upper and lower chambers of her heart. Dr. Iwai destroyed the redundant fibers, using radiofrequency ablation, similar to the heat from a microwave.
The procedure, called catheter ablation, took approximately two hours, after which Moskowitz stirred from her sedation and asked when she could work out. Dr. Iwai told her to rest for four days, then jump back in at five, mostly so the veins in her legs could heal from the catheter insertions. She complied, joking to her fiancé that waiting to exercise would be “the hardest part” of this ordeal. Without missing a beat (so to speak), she was back home in Pleasantville, back to work in Ossining and soon exchanging vows on a Hawaiian beach.
“I credit my CrossFit background with helping me heal,” she says. “I was told that your healing time and outcome are so much better if you’re active and healthy than if you’re sedentary. There’s no other way I’d be doing sprints and squats a few days after cardiac surgery.”
According to Dr. Iwai, “Courtney has no heart problems.
“It’s gratifying,” he continues. “We can treat conditions such as hypertension, cho- lesterol and coronary disease. However, SVT is something we can often cure.”
CARDIAC CARE AT WMCHEALTH
Westchester Medical Center Maria Fareri Children’s Hospital, 914.909.6900
MidHudson Regional Hospital, 845.483.5720
Good Samaritan Hospital 845.368.5620
HealthAlliance Hospital: Broadway Campus, 845.331.3131
Margaretville Hospital, 845.586.2631 ext. 3245
Photos By Kenneth Gabrielsen