Missy’s story: trigger unknown

Photo attribution JESHOOTS.com from Pexels

Life prior to TTS
I had breast cancer and lost my son three years prior to having TTS. The day he passed just keeps coming every year and  I lost eight loved ones in a two year period, plus a dog and cat. My whole life has been stressful.  I had a myocardial infarction (heart attack) in August 2017 with a stent put in.

Triggering event for TTS: Unknown
I cannot relate anything happening the week prior to this attack, although I was worried about money and getting a window fixed. I woke up Friday night about 11pm to go bathroom, had some heartburn, took pepcid then started with the crushing chest pain, and pain in upper back. I took three 81 mg chewable aspirin and two Nitro (anginine) tablets 5 minutes apart. My daughter drove me to hospital.

Medical management
We arrived at the hospital at 12am Saturday. After an EKG was done, I became diaphoretic (sweaty), nauseated, and short of breath. I received low dose oxygen and was taken to a room, then started vomiting. I had an intravenous (IV) cannula put in and medications for nausea were given. A portable chest x-ray was done. A Nitro drip was started but it was weaned off at 7:30am on Saturday morning as I was free of pain at that time. I have an abdominal aortic aneurysm (AAA) and I was sent for a CT scan to rule out a rupture of the AAA. I was not sure what else they were looking for. I was admitted to the cardiac ward and the cardiologist did an angiogram (cardiac catheterisation) which showed no heart attack, but TTS. I was started on BuSpar (an anti-anxiety medication). The next day, I had an echocardiogram. I had another two episodes of the chest pain, which resolved after receiving oxygen and two Nitro’s. At 4am on Sunday, I went into atrial fibrillation that was treated with IV metoprolol and a Cardizem (diltiazem) drip. I converted back to normal sinus rhythm and the Cardizem drip was weaned off. In between this EKG’s were taken a few times. My blood pressure ran very low for at least 24 hours. I was started on Eliquis (apixaban) 5mg twice a day and discharged with oxygen, Eliquis and BuSpar.

Life after TTS
I felt lost and did not have a real understanding of this disease.  I was really angry at my cardiologist because I felt he should have spoke with me after the cardiac cath (angiogram). On Sunday, the Cardiologist’s Nurse Practitioner spoke with me and showed me my heart on the screen and explained what the disease was doing and I could see it for myself.  I felt better because I know how to fight back now. I do not believe the nursing staff were up to date on this disease. No one seemed to know anything. The doctor assigned to me was great.  He tried so hard to explain it to me, but it was not sinking in. Between him and my cardiologist, it seems that I had the right orders given as I am here to tell the tale. Following discharge I was to have follow up with cardiology within 4 weeks and follow up with primary care physician (PCP) in 2-5 days (but cannot get appointment until 16 days). Medications: The aspirin I was taking prior to my TTS was ceased and  I continued taking Eliquis, BuSpar, acetaminophen/codeine tablets for pain  (at 7-10 pain scale) for 5 days. I resumed the rest of my pre-TTS medications. At this time, it’s only been one day since hospital discharge. I am short of breath with just a few steps, and exhausted. I am using the oxygen that I was discharged with as required. I have not had any more pain.