Helen’s story: Pottering in the garden

Life prior to TTS
Helen is a very fit active 61 year old lady with no prior illness. She is a non-smoker and has no alcohol intake. She was a teacher and took early retirement and had no stress or anxiety issues.

Triggering event for TTS: Unknown
I was pottering in garden when I felt unwell with pain in my chest, nausea, and sweating.I went to bed and slept solidly for a few hours. My daughter called in and thought I looked quite grey in colour and called emergency services. I was taken by ambulance to the local hospital as my ECG was not normal. My blood tests showed raised troponin. I was transferred by helicopter to the mainland for angiogram and echocardiogram whre TTS was diagnosed.

Medical management
The angiogram showed no blockages but the echocardiogram showed ballooning of heart. I was referred to local community cardio nurse. There was no arranged follow up care locally by cardiologist.

Life after TTS
I had two more events but was dismissed by the local cardiologist so arranged a private consultation with a doctor at a hospital in London who specialises in care of patients with TTS.  He arranged two more follow up MRI scans and echocardiograms as my ejection fraction was still low and my mitral valve is leaking and being monitored. He has diagnosed microvascular angina . My medication has been changed over the past two years and am now taking Ranalozine 500mgs twice daily which has been a great help with the chest pain. Also take carvedilol, ramipril, bumetanide, atorvastatin and have a GTN spray. I still have a problem with shortness of breath and tiredness.

Key Point: Microvascular disease (MVD) is a condition that results in impaired delivery of blood through the smallest vessels that supply the heart muscle (pre-arterioles, arterioles, or capillaries).  Though the large arteries supplying the heart muscle are normal, normal exchange of  oxygen, nutrients and removal of waste is impaired.  Some studies suggest that MVD may be a contributor to the development of TTS, though the exact mechanism by which this occurs is not yet known.