Heart attack leads to takotsubo

Doctors were surprised to discover Kathleen’s heart attack had triggered a second, more unusual, heart condition – takotsubo cardiomyopathy. Now she’s celebrating the fact she’s here to tell her story.

Even before her own heart events, Kathleen was no stranger to heart disease. Her partner Ray died in October 2011 at just 48, after he had a heart attack while playing football. And there was a history of coronary artery disease in Kathleen’s own family – her mother was diagnosed with the condition in her seventies and treated with a stent.

It was hardly surprising Kathleen felt anxious about her own heart health, so in early 2012 she booked an appointment with a private cardiologist who organised an ECG treadmill test (PDF), as well as a cardiac calcium scoring test (a type of heart scan that gives a more accurate assessment of heart attack risk).

The tests came back clear and Kathleen was told she wouldn’t need to visit the cardiologist for another four years.

However the following year a test at her local supermarket revealed high blood pressure, so she returned to her cardiologist. After a 24-hour blood pressure monitor (PDF), she was prescribed medication to lower her blood pressure.

Test results also showed a rise in Kathleen’s cholesterol. Although she was going through menopause, which increases a women’s risk of heart disease, her GP and cardiologist felt there was no need for medication at this stage, as the result wasn’t overly high.

Prescribed statins

In February 2017 Kathleen returned for another cardiologist appointment. Her cholesterol was still high, so the cardiologist recommended a low dose of statin

“I had no hesitation in starting the statin because it seemed no amount of diet and/or exercise was bringing the cholesterol levels down,” she says. 

Ironically, at that same appointment Kathleen asked her cardiologist how she’d know if she was ever having a heart attack.

“The cardiologist said, ‘Everybody’s different but it feels like it’s a pain on your chest. Some women say you feel like you want to take your bra off’.”

Just six days after that appointment Kathleen experienced her own symptoms, when she had a heart attack, followed by a takotsubo cardiomyopathy event.

Heart attack symptoms

It was early Sunday evening and Kathleen had been vacuuming vigorously when she noticed some strange symptoms.

“I was sweating profusely, like I’d never sweated before. I actually went to the mirror and the sweat was just pouring down my face. And there was a pain in my chest. It was uncomfortable, but it wasn’t unbearable. I didn’t for one moment think I was having a heart attack.”

Although the symptoms persisted, Kathleen headed to her sister’s house for a BBQ. On arrival she noticed that her arms and legs were “feeling funny” and asked her sister to take her to A & E.

Her sister drove her to the local after hours medical clinic, which typically had a huge queue of people in the waiting room.

“There was a massive amount of people there and when I saw that I told my sister that I couldn’t wait!”

Sensibly her sister alerted the receptionist to Kathleen’s chest pain and she was seen immediately. The medical team gave her an aspirin to chew and GTN spray before putting her in an ambulance to Auckland Hospital.

“When I arrived in the wheel chair the staff were saying, ‘She’s going directly to resus’. In my head I’m thinking ‘Oh goodness what the heck’s going on here?’”

Her concern grew when she heard one of the doctors mention troponin – a protein that appears in the blood following a heart attack.

“So now I’m thinking, ‘Holy heck, I’m having a heart attack!’ And the pain wouldn’t go away.”

Angiogram reveals two different conditions

By 1am, after some morphine, the pain started to subside and at 8.30am Kathleen underwent an angiogram.

The angiogram showed that one of Kathleen’s coronary arteries was almost completely blocked so the medical team inserted a stent.

However, the angiogram also revealed a second problem. Kathleen had takotsubo cardiomyopathy, a condition which is often brought on by extreme physical or emotional stress.

“The doctors started asking unusual questions, like had I had a terrible shock? Had I had shocking news just recently? And I said, “No, I actually had had a really lovely relaxing weekend.”

The doctors concluded that the physical stress of the initial heart attack had triggered the takotsubo event, which occurred immediately afterwards.

Heart events a real shock

Kathleen says both the heart attack and the takotsubo diagnosis came as a real shock.

“I guess I’ve always been somebody that’s been fit and healthy. I exercise regularly, I don’t eat lots of processed foods, I’ve always looked after myself. So having the heart attack and then having the takotsubo was a real shock.”

It seems her doctors felt the same way.

“The cardiologist and my GP contacted me after I got out of hospital. They both rang me and said, ‘Kathleen you were not even on our radar as a suspect for a heart attack or then a takotsubo’.”

Successful recovery

Kathleen has recovered well from her heart events. She attended cardiac rehabilitation classes run by the local DHB and has regular check-ups with her cardiology team.

“The cardiologist continues to keep a close eye on me which is good. I have echocardiograms and my heart has recovered really well after the takotsubo.”

Even so, Kathleen still feels “twitches and twinges all the time”. She says it was helpful to speak to others at a takotsubo support day, who were experiencing similar symptoms.

“It was good to see that other people are still experiencing the same feelings. I don’t know if you ever go back to a relaxed state of ‘pre-incident’.”

Kathleen says that one of the hardest things to deal with has been the lack of concrete information about what caused her heart events – and that has had an impact on her confidence.

“Of course there’s all the normal things, like healthy diet and exercise, but I have never been inactive or eaten unwisely, so for me, I can’t pinpoint why it happened, however I’m delighted that I’m here to be telling this story.”

Advice to others

Kathleen urges others to call for help as soon as they experience heart attack warning signs – even if they don’t believe they’re having a heart attack.

“The thing that was the biggest shock for me was that I didn’t actually know I was having a heart attack. My only advice is if you’ve got any heart attack symptoms, even ones in your arms and your legs, call 111.”

“I am blessed with a very supportive family, grateful to everyone in the Critical Care Unit at Auckland Hospital and absolutely delighted to still be here.”

 

Shared May 2019

Please note: the views and opinions of the storyteller and related comments may not necessarily reflect those of the Heart Foundation NZ.

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