Hershel Schabes keeps a very busy schedule for a man in his 70s. An accountant for more than 40 years, he maintains a part-time practice for several clients.

Schabes balances his workload with exercise and racquetball three times each week at a local fitness center in Towson, Maryland. He stays grounded in his faith by attending services at his synagogue as often as possible.

Schabes has a family history of heart trouble — his father passed away from a heart attack, and both of his younger brothers have had stents inserted. Because of this, Schabes has always been mindful of his health, and he credits this for his high activity level.

Last year, Schabes began to experience troubling symptoms that threatened his active lifestyle.

Mysterious Fainting

His health problems started mysteriously in June 2023. While Schabes was visiting his mother at a nursing home in New York, he took her to an outdoor patio to get some fresh air and unexpectedly collapsed and passed out. A staff medic urged him to seek care.

Schabes went to a nearby hospital, where he was kept under observation for two days, and tested and cleared of common heart conditions. The doctors said dehydration or a blood pressure issue might have caused the problem, but they could not offer a specific diagnosis. Schabes was sent home with a monitor at the direction of an electrophysiologist. One month later, during a return visit to the electrophysiologist, Schabes’ heartbeat was a bit irregular, but again_, nothing was conclusive.

Back home, in August, Hershel was driving early one morning to his synagogue when he had another fainting episode. After he passed out, his car struck two parked cars and went over a curb, triggering the airbag to open. Remarkably, after providing details about the incident to police, Schabes started walking to the synagogue, but a neighbor insisted on giving him a ride. At the synagogue, he started leading services and soon fainted again. He was taken to a hospital for treatment, but again, results of testing were inconclusive. After a follow-up consultation with two cardiologists, Schabes was given an implantable loop recorder (ILR) to monitor his heart’s electrical activity. The ILR did not record anything out of the ordinary for a few months.

A Disrupted Life

After the car accident, doctors told Schabes not to perform vigorous exercise or drive. He walked to many places instead, but this was very stressful for loved ones, who worried he would faint. For rides, Schabes depended on family members, especially his grandchildren.

Seeing the mysterious condition’s impact on Schabes’ daily life, his primary doctor referred him to Ronald Berger, M.D., Ph.D., an electrophysiologist at the Heart and Vascular Institute at Johns Hopkins.

During his first appointment with Berger, Schabes extensively detailed his fainting experiences. He appreciated how Berger listened to the entire journey that brought him to Johns Hopkins, especially an odd detail: Schabes felt fine after fainting.

A Diagnosis, at Last

Berger primarily treats patients with arrhythmias, which are abnormalities in the timing or pattern of the heartbeat. Based on Schabes’ story, Berger suspected the problem lay in the way the brain receives a signal from the carotid artery pressure sensor and controls the heart rate, leading to sudden pauses in the heartbeat.

Using a carotid sinus massage — a simple diagnostic procedure to identify heart rhythm problems — Berger triggered a brief episode in the office, causing Schabes to pass out. This confirmed that Schabes had carotid hypersensitivity — a condition in which pressure on the side of the neck provokes a reflex that causes the heartbeat to abruptly pause, resulting in sudden fainting.

The solution was simple. Berger scheduled surgery to install a pacemaker to regulate electrical impulses sent to the heart and help Schabes avoid the rapid drops in heart rate that triggered his fainting. The pacemaker surgery was completed smoothly, and Schabes has not passed out since then.

Lifestyle Restored

Schabes describes his initial appointment with Berger as “the best medical experience I’ve ever had.” He feels his case highlights the importance of expert care. Schabes saw four cardiologists before his appointment with Berger, without finding an answer for the fainting spells. Schabes credits Berger’s knowledge and experience for quickly and accurately diagnosing the condition.

Schabes is now able to drive again, and he has resumed his regular activities — work, racquetball and going to synagogue — without issue.