Karen’s story: Physical activity (cycling)

Karen, a Registered  Psychotherapist, was 52 when she was diagnosed with Takotsubo syndrome (TTS). She has hypothyroidism but was usually a fit person who looked after herself. For the preceding four months, Karen had felt more tired than usual, but this didn’t prevent her from walking and cycling and being very active.

Takotsubo trigger
On the day that Karen’s TTS occurred, she had cycled for 11 miles without any hint of difficulty. She and her companions stopped for tea and cake, and at that time she was experiencing no problems. 4 miles into the return cycling journey, Karen experienced a peculiar surging sensation in her head and instantly lost all power and energy. She slowly made it back home, but she was feeling very ill with chest pain and was cold and shaking. Once home, the ambulance was called.

Medical Management
Paramedics took Karen to the hospital with suspected heart attack. On arrival Karen had an electrocardiogram (ECG), echocardiogram, and coronary angiogram. Fortunately, the doctors knew what the condition was and immediately diagnosed TTS. Karen’s troponin peak was uncharacteristically high for TTS (4450) and her ejection fraction (EF) at that stage was 25%. Karen stayed in hospital for a week and had an MRI to confirm the diagnosis. When she left the hospital her EF was 67%.  Karen was discharged on an ACE inhibitor (Ramipril), beta blocker (Bisoprolol), aspirin, diuretic and statin.

Life after Takotsubo syndrome
6 weeks after her TTS diagnosis, Karen attended a 6-week cardiac rehabilitation program at the local hospital which she found very helpful. Karen still felt tired 3 months after her TTS diagnosis, but at the 4-month mark her energy levels have begun to improve, though she still has a way to go.  An MRI 3 months after diagnosis showed resolution of inflammation in the heart and Karen was advised to stop the beta blocker, aspirin and diuretic medications and start exercising with caution.  Karen is undertaking a 12-week cardiac rehab program at the local gym. She was advised to continue to take the ACE inhibitor medication to protect her heart.