Lisa Smith,

Thanks for your posted question about your friend with a recent problem.  It's impossible to say what caused his episode without taking a history and examining him.  That's why I'm recommending that he contact his physician for an appointment for a full evaluation.  His doctor may request laboratory work as well as other testing.

The possibilities here are many.  With his history of swollen feet and ankles, smoking, and borderline diabetes, this could be a metabolic problem related to his diabetes, a cardiac issue such as an abnormal rhythm, neurologic, or vascular disorder.  But to make an accurate determination would require a face to face visit.  Because this could happen again, I'd suggest getting an appointment as soon as possible.

Please ask him to review our website, especially the diabetes, smoking cessation, and heart areas for information to get him started on a healthier lifestyle.

Best wishes.

Martin Cane, M.D.