Life prior to TTS
Jimmy was in the army reserve for 18 years, has completed a couple of 10km runs, walks about 3 miles a day, and more at the weekends. He says that he is overweight, but has no other health issues. Jimmy tells his story below.
Takosubo trigger: Scuba diving
On Monday the 17th of August I went scuba diving at an inland dive centre in Dorset. This was my 20th dive, but the first of that day. We got in the water about 3pm, and made our way down to 6 metres (m). At 6m we made sure we were happy and good to continue. We made our way down to 20m over the next 10-15 minutes and all was OK.
At 20m, I started to feel a tightness in my chest, and it felt like I wasn’t getting enough air into my lungs. Trying to keep my cool and not panic, we were making our ascent to a plateau at 12m anyway, I rode it out for a while to see if the pressure change helped. It didn’t!
I signaled to my buddy that I wasn’t happy, and I wanted to surface. He signaled back that we will ascend slowly, and we stopped at 6m for our safety stop. During the ascent my breathing got worse and I couldn’t control my coughing.
Once on the surface I stripped off my mask, regulator, hood, and loosened my wetsuit. I paddled to the side to get back out, now with a massive headache, dizziness and nausea. I dumped all my gear and my buddy got the medics, who took me inside and put me on oxygen and called the ambulance and the nearest hypobaric chamber in case it was the bends.
The dive doctors decided that they did not need to see me and the paramedics called for the air ambulance. When the paramedics hooked me up to the ECG they became very concerned, and confused. The read out looked really bad, but I was sat up talking and breathing, with chest pains and still coughing. The air ambulance arrived and the flight doctor said I was ok to go by road to hospital.
On arrival in ED a heart attack was ruled out with blood samples. They did a chest x-ray and CT, which showed minor scarring/damage to the lungs. The dive doctors in Plymouth wanted to speak with me to document what had happened. I was kept in overnight on oxygen.
The next day I was visited by about 6 doctors and consultants, each telling me I was a bit of a mystery. The respiratory doctors had looked at my x-rays, had a meeting and decided that the damage on my lungs was only minor, and should heal on its own, and that in their opinion the lung problem was caused by a heart defect, not vice versa. It was mentioned by one doctor that it could be a left bundle branch block. At this point I needed an echocardiogram, and depending what that found would dictate if I needed a CT angiogram or an angiogram (camera inserted to an artery in the wrist to see inside the heart).
Friday morning I finally got my echocardiogram, and it looked good apparently. It showed mostly normal functioning. Now I needed a CT angiogram. 4 days later on the Tuesday afternoon I got it done. The Cardiologist said I still need an MRI scan, but it looks like I have Takotsubo. I was then referred back to my GP, to refer me to my local cardiology department as the hospital that I was taken to is about 100 miles from where I live! I was also prescribed 75mg aspirin per day.
Life after TTS – early days
Things are still ongoing for me at the moment, I am still waiting on news about treatment, if any, and I’m speaking with my new cardiologist today, so hopefully we can get an MRI booked in. But before that, I need a tiny fleck of metal removed from my eyeball! But for now, I get tired easily, and get minor chest pains, and breathless but only for a couple of breaths. I can’t stand sitting around all the time, but I am listening to what my body is telling me.
Key Point: Several members of our Takotsubo Support Group have reported scuba diving as their trigger for TTS. There are now numerous published cases of scuba-related TTS which may present as immersion pulmonary oedema (IPE). All cases of IPE should be investigated for TTS as soon as possible after treatment has been instituted (Ng & Edmonds 2015).