Mr. Beckmen was afraid that it might be his heart, "I had a heart valve replaced in 1982 and I thought it might be related to that," he says. He decided to go to the Mayo Clinic in Rochester, Minn. There, he underwent a complete evaluation by electrophysiologist Win K. Shen, M.D. An electrophysiologist is a cardiologist with special training in the diagnosis and treatment of heart rhythm disorders. Fainting - doctors call it syncope (sin-ko-pea) - is sometimes a symptom of an abnormal rhythm of the heart, which shows itself in this unexpected and frightening way.

Doctors at the Mayo Clinic ordered a number of tests for Mr. Beckmen, including an electrocardiogram, and echocardiogram (ultrasound of the heart), a stress test and a tilt table test. None of these tests revealed what might be causing his bouts of fainting.

"When we applied slight pressure over the artery in his neck, however, we were able to reproduce the feeling of faintness and we could detect a slowing of the heart beat and a drop in blood pressure," said Arshad Jahangir, another electrophysiologist at the Mayo Clinic.

Because of this special symptom, and the normal test results, the doctors were able to tell Mr. Beckmen that his problem was not related to the valve replacement surgery he'd had years before. Instead, the diagnosis was carotid sinus syndrome, a type of fainting known as neurocardiogenic syncope. "It's caused by a nerve reflex in which the heart or vascular system overreacts to pressure over the carotid (neck) artery," Dr. Jahangir said. Symptoms usually occur with neck movement, such as while shaving or turning the head while reversing a car, or from wearing a too-tight collar. "When this happens, the heart rate and blood pressure can decrease dramatically. The result is severe lightheadedness and fainting and, often, the patient falls." The elderly are particularly vulnerable to this type of fainting because of age-related conditions that may limit blood flow to the brain or medications or other factors that may cause them to become dehydrated.

Fortunately, carotid sinus syndrome can be treated. In Mr. Beckmen's case, the doctors implanted a pacemaker that detects when his heart rate slows down - one of the effects of the exaggerated nerve reflex that precedes a fainting episode. When this happens, the device paces the heart at a faster rate to prevent or minimize his symptoms. It worked for him, and allowed him to continue to maintain the lifestyle he enjoyed before, without the fear and worry that had disrupted his daily routines.

Several months ago, Mr. Beckmen suffered a heart attack that was not related to his carotid sinus syndrome. "While I was in the hospital, they tested my pacemaker and said it was still working fine after all these years."

Today, Mr. Beckmen is 78 years old. Despite his medical problems, he continues to be physically active. "I mow my own lawn, trim the bushes and do work outside. We also have an active family life - my wife and I have four children and many grandchildren who all live within 30 miles of us."

"It's been nearly 10 years since I had my pacemaker implanted," he says, "and I've never had another fainting episode."

This is a story that ends on a happy note; like many others who have experienced this problem, Mr. Beckman's active lifestyle has been restored through the use of technology.

This patient story may not be typical. Individual symptoms, situations and circumstances vary and response to therapy is not always the same. Please consult your physician or health care provider regarding your condition, treatment or any specific questions regarding your care.