A Family's Test of Heart

Three years ago, the Stitchick family of Avon was enjoying a summer Sunday morning on Lake Erie in Sandusky. Their contentment was shattered when youngest son, Josh, fell inside their camper.

“I found Josh unconscious on the floor,” says his mother, Anita. “He wasn’t out for long, but it was long enough to be worried.” They took Josh to the emergency department (ED) at a local hospital, where they monitored his vital signs but made no formal diagnosis, telling them to take Josh home and follow up with his pediatrician.

About 10 days later, a second incident occurred, along with another trip to a different ED. Results from a CT scan were normal, so Josh was again sent home, but this time with instructions to follow up with a neurologist, who ran a battery of tests with results all coming back normal.

“As month after month went by, we started to think, ‘Maybe everything is ok,’” says Anita. But shortly after getting home from school one day, Josh had another episode — one that looked a lot like a seizure. A call to 911 brought paramedics to the home, but because Josh was awake and stable, they instructed the Stitchicks to take Josh to Cleveland Clinic’s Richard E. Jacobs Health Center in Avon.

The ED physician talked with Josh, who mentioned having felt dizzy prior to the episode. That led to an EKG test, which showed an irregularity in his heart function.

The board-certified emergency medicine physicians at Richard E. Jacobs Health Center and all Cleveland Clinic emergency departments are trained to look for symptoms of an underlying condition and provide access to specialty medical care. In Josh’s case, an EKG confirmed that Josh needed specialty care, so the ED team coordinated an immediate referral to a pediatric cardiology specialist at Cleveland Clinic.

“We’re so grateful to the physicians at the Avon ED and Dr. Aziz, who is doing all he can to help kids like Josh have a normal life."

Josh was transported by ambulance to Cleveland Clinic Children’s on main campus, where he was seen immediately by pediatric cardiologist Peter Aziz, MD, and admitted to the pediatric intensive care unit.

“Josh was diagnosed with Long Q-T syndrome — a disorder of the heart’s electrical system,” says Dr. Aziz. “The Q-T interval of the heart represents the time it takes for the heart muscle to contract, then recover. In those with Long Q-T, a defect causes a delay in that time, which can lead to fainting, seizures or even sudden death.”

Josh was started on a beta blocker medication to help his heart beat more slowly and with less force. Dr. Aziz also performed a simple procedure to insert a very small cardiac monitor just under the skin in his chest to track his heart rhythm at all times. Wireless communication allows data from the device to be transmitted to Cleveland Clinic for review by Dr. Aziz.

“I told Josh I’ve got to get to know his heart better,” says Dr. Aziz. “He’ll always be a patient of ours because Long Q-T is a chronic illness — we can treat it, but we can’t cure it. By monitoring his heart rhythm, if he does have an event, we can learn more about what happened.”

In the event of an emergency, the Stitchicks have an automated external defibrillator (AED) that can shock Josh’s heart back to a normal rhythm. “These devices are really sophisticated,” says Dr. Aziz. “If Josh ever becomes unconscious or unresponsive, the AED can augment what they can do for him. If he is having a heart rhythm problem, the device will tell them.”

According to Dr. Aziz, the actions taken at the Avon ED and subsequent referral for pediatric cardiology care have helped ensure that Josh’s future is optimistic. While he does have some limitations — he isn’t supposed to play contact team sports and should avoid activities that can cause his heart to race — everything is up for discussion to evaluate risks and benefits.

“We’ve been through a lot, and still have a ways to go to find what will be a new normal for our family,” says Anita. “We’re so grateful to the physicians at the Avon ED and Dr. Aziz, who is doing all he can to help kids like Josh have a normal life. With support from family, friends and community, I want to channel our experience and do what I can to make others aware.”