For Susan Saunders, Ozempic initially seemed like the long-awaited solution to a struggle that had defined much of her adult life.
The 77-year-old retired teacher had spent decades attempting to manage her weight through programmes including Slimming World and Weight Watchers. Diagnosed with type 2 diabetes in her 40s, she had also faced the health consequences of the condition for years.
When her doctor recommended the injections, Susan says she was thrilled by the prospect.
However, her experience soon began with a side effect so familiar that many people would not consider it a potential warning sign.
Within months, Susan began experiencing repeated vomiting — a recognised complication of weight-loss injections, reported to affect as many as four in ten patients.
In her case, though, the episodes triggered a serious medical crisis, leading to a little-known heart condition that can be fatal in its most severe form.
She initially tolerated the injections without major difficulty. But after her dosage was raised, Susan developed overwhelming fatigue, nausea and vomiting.
‘It was horrid,’ she says. ‘It made me so exhausted. I would often retire to bed early and keep a bowl by my bed, ready to throw up.’
For many people taking GLP-1 drugs, nausea and occasional vomiting are considered an acceptable trade-off for weight loss and the prospect of improved health.
Then, during a visit to her sister in November 2021, her symptoms escalated sharply. Susan was suddenly struck by a severe vomiting episode that appeared to continue without end.
‘I threw up until there was absolutely nothing left,’ she said. ‘I was throwing up pure bile.
‘I felt terrible and was utterly drained by the time it finished. I curled up on the bed in my sister’s spare room.’
The following morning, Susan woke at 5am in a panic, with pain spreading from her left shoulder into her upper arm and across her chest.
She called her doctor, who urged her to go to A&E immediately.
Hospital doctors suspected a heart attack after finding raised levels of troponins – proteins released into the bloodstream when the heart muscle is damaged.
She was transferred to a specialist cardiac hospital for further tests.
But doctors there discovered her arteries were not blocked – a typical hallmark of a heart attack – and the damage to her heart muscle did not follow the usual pattern.
‘The doctor came to my hospital bed as though a lightbulb had gone off,’ Susan said. ‘He said, “You’ve got takotsubo.”‘
Takotsubo syndrome, also known as takotsubo cardiomyopathy, is a potentially life-threatening condition in which the heart’s main pumping chamber suddenly weakens.
While its exact cause is unknown, experts believe a sudden surge of stress hormones, such as adrenaline, can temporarily disrupt the heart’s ability to pump properly.
Emotional stress is a well-known trigger – earning the condition its nickname, ‘broken heart syndrome’.
The main symptoms are sudden, intense chest pain and shortness of breath, meaning the condition is often mistaken for a heart attack.
Less common signs include heart palpitations, nausea and feeling faint.
And while the syndrome – which affects around 5,000 people in the UK each year, most of them postmenopausal women – is rare, it can have devastating consequences.
It causes a sudden change in the way the heart muscle contracts, reducing its ability to pump blood effectively around the body.
In severe cases, this can lead to complications including stroke, heart failure and even fatal cardiac arrest.
Susan’s doctors said her condition was likely triggered by the intense vomiting caused by the weight-loss injections, which are taken by an estimated 2.5 million Britons and work partly by suppressing appetite and making people feel fuller.
‘Takotsubo happens when a sudden flood of stress hormones like adrenaline sends the heart muscle into shock,’ Dr Oliver Guttmann, a consultant cardiologist at HCA’s Wellington Hospital in London, tells the Daily Mail.
‘Emotional shocks can cause it, but physical stress is also a common trigger.’
Severe vomiting – one of the most commonly reported side effects of the jabs – could provide just such a trigger, Dr Guttmann explains.
‘This leaves you dehydrated and low in salts like potassium, which the body responds to by pumping out adrenaline,’ he says.
‘For some people, that is enough to trigger the syndrome.’
Earlier this year, doctors at Inspira Medical Center in the US highlighted a possible link between takotsubo syndrome and weight-loss injections in a medical paper published in the American Journal of Respiratory and Critical Care Medicine.
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They described a 56-year-old woman who developed uncontrollable vomiting and nausea after starting a high dose of Ozempic.
Tests carried out after she was admitted to hospital revealed the telltale signs of takotsubo syndrome.
The doctors warned that patients should start on the lowest appropriate dose and that potentially concerning symptoms, such as persistent vomiting, should be closely monitored as doses are increased.
Importantly, large-scale studies have found that GLP-1 receptor agonists can reduce the risk of major cardiovascular events, such as heart attacks and strokes, by around 15 to 20 per cent.
However, rare case reports have raised the possibility that severe side effects from the drugs – particularly prolonged vomiting – could, in some patients, trigger acute heart problems such as takotsubo syndrome.
Writing on the social media forum Reddit, one user said the injections triggered vomiting accompanied by chest pain, heart palpitations and a rapid heartbeat.
Another described symptoms that mimicked a heart attack after taking Wegovy, which also contains semaglutide.
‘I was on the floor/doubled over/crying and considering going to the emergency room,’ they said. ‘[What] I was experiencing felt exactly like being stabbed in the chest; I thought I was having a heart attack but after calming myself down and sitting still, I felt better after approximately 14 hours.’
A separate case report, published by scientists at the University at Buffalo last year, detailed takotsubo syndrome in a woman taking tirzepatide, better known by the brand name Mounjaro.
The 44-year-old, who had bought the drug for weight loss, developed vomiting and stomach pain before being rushed to A&E.
Researchers concluded that the high dose had triggered the symptoms that led to takotsubo.
Official UK drug safety data reveal that, since 2019, there have been 443 reports of suspected cardiac reactions involving the jabs, more than 300 of them in the past two years.
Of these, 210 were classified as serious, while 14 involved a fatal outcome, according to reports logged under the Government’s Yellow Card scheme.
Yellow Card reports to the Medicines and Healthcare products Regulatory Agency can be submitted by patients, medical professionals and drug manufacturers.
Crucially, they do not prove that a medicine caused the reported problem – only that the person submitting the report suspected a possible link.
Dr Guttmann says certain patients may be at greater risk of takotsubo syndrome, including older people, who can be more vulnerable to dehydration.
Most sufferers make a full recovery, as Susan did, with regular monitoring and measures to reduce stress.
She quit Ozempic almost immediately after her diagnosis, but began using Mounjaro early last year, fearing she might regain the weight she had fought hard to lose.
She says the nausea has been ‘non-existent’ and she hasn’t vomited once since starting it.
The case comes amid growing scrutiny of other potential complications associated with weight-loss jabs.
Earlier this month, the Daily Mail revealed reports from patients who developed thyroid cancer and suspected their injections may have played a role.
Early safety studies found the drugs caused thyroid tumours in rodents. However, experts have not established a clear increased risk in humans.
Meanwhile, a study published this week found patients taking the drugs were 11 times more likely to suffer a potentially deadly complication during surgery than those not using them.
British experts said patients on the jabs must be warned about the risk of regurgitation – when food or fluid in the stomach travels back up towards the throat while a patient is sedated.
This can lead to pulmonary aspiration, when stomach contents enter the lungs, potentially blocking the airways and causing serious lung damage, infection and, in the most severe cases, death.
Susan urges those starting the drugs to ‘take it very slowly’.
‘Enjoy the weight loss, but stick to the minimum amount you can manage with comfort,’ she says.
‘If you do get chest pains, take yourself off to A&E immediately.’
A spokesman for Novo Nordisk, maker of Ozempic and Wegovy, said: ‘Like all medicines, treatments used for chronic conditions can have side effects, and these can vary from person to person.
‘That is why medicines should be prescribed by, and used under the supervision of, a healthcare professional, who can consider the potential benefits and risks for each individual.
‘While gastrointestinal side effects are well characterised and described in the Summary of Product Characteristics, available data do not support a causal relationship between semaglutide and takotsubo syndrome.’