Toni was 59 years old and married with four grown children and 9 grandchildren who kept her busy. She worked in her husband’s office three days a week, was an active church-goer, looked after the children for two hours every Sunday at her church, and enjoyed researching family history.
Takotsubo trigger
Toni lived three hours drive away from her Mum but saw her whenever she could. Toni’s Mum, aged 80, had a heart condition and was admitted to hospital. Her family anticipated that she may need to go into an aged-care home, but they did not expect her to die during the hospital admission. Toni was notified that her Mum’s condition had worsened and she died 5 hours after Toni got to the hospital. The first year following her Mum’s death was difficult for Toni and she missed her Mum dreadfully, but she coped with her grief.
On the day following the first anniversary of her Mum’s death, Toni and her husband made the three hour journey to see her brother and sister, and to visit her Mum’s grave. Toni felt okay during the drive, but after not having seen her sister for a year, they felt quite emotional and cried together at their Mum’s grave. As Toni and her husband walked back to the car, he asked her if she was alright. She told him that her ‘heart hurt’. Although she had a slight stabbing pain at that point in time, she was referring more to the feeling of sadness that she was experiencing, although there was a little bit of pain. Soon after, Toni had a gripping pain in the right side of her chest that went down her right arm. She had difficulty breathing and asked her husband to pull the car over. Her sister was in the car behind and also stopped. Toni was experiencing pain from her stomach right up into her head and she says that her head felt as if it would explode! Gradually the pain became less intense, although she still had some residual discomfort in her arm and shoulder. Toni did not think that she was experiencing a heart attack as her pain was not in the left side of her chest. She, and her family, thought it must be an anxiety attack due to the emotions felt during the day. Later, the family met up to go out for dinner, but during the meal, Toni still had pain and felt sick, as well as feeling a bit dazed, confused , and tired. On returning home, she went straight to bed but awoke at 1.30am with left-sided pain that felt like a ‘muscle spasm’. She had previously experienced spasms in her back and thought this was a similar problem.
Medical management
When her husband awoke at 6am they decided that she should go to see her doctor, who sent her straight to the hospital, where tests indicated that she may have had a heart attack. Following an angiogram the next day, TTS was diagnosed. Toni questioned why this should have happened on the anniversary of her bereavement, rather than at the time.
Key point Although TTS often happens at the time of bereavement, it is also common for it to occur on the anniversary of bereavement, particularly on the first anniversary. Perhaps it is because people know the date is coming, and it is a culmination of a year of grief and loss and re-living the distress caused by the events on that date a year ago.
