Takotsubo Story Template

Takotsubo story template

Takotsubo Story Template • Please complete the template in your own words. The headings below will guide you as to the information that can be included. • Attach the template to your email (or paste the text into the email). • Please supply your first name for the story (or an alternate name of you would prefer not to use your own). • Please supply an email address. This will only be used so that I may contact you once the story has been edited to get your approval to put it up online.

  • Please include any related pre-existing illness or stresses and any social details that you would like to share, such as fitness levels, job, family, etc.
  • Please supply a summary of events leading up to the episode. Describe the actual trigger (if known) Describe the symptoms Details of contact to emergency services/assistance.
  • Please supply a summary of how you were treated in hospital and any tests that you had such as coronary angiogram, MRI, echocardiogram, CT, etc) Describe any in-hospital complications Please list discharge medications. Please describe any referrals to health services and follow up care.
  • Please describe your recovery, any on-going symptoms, representations to ED. Please describe follow up care and tests. Please discuss any subsequent illnesses or conditions that developed after TTS.
  • Please include any other information that you would like to share or that you think is relevant.

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