Happy Heart Syndrome: Takotsubo Syndrome Triggered by Positive Events

Jun 28, 2022
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Authors:
Stiermaier T, Walliser A, El-Battrawy I, et al.
Citation:
Happy Heart Syndrome: Frequency, Characteristics, and Outcome of Takotsubo Syndrome Triggered by Positive Life Events. JACC Heart Fail 2022;10:459-466.
Summary By:
Bina Ahmed, MD, FACC

Quick Takes

  • The authors describe prevalence, clinical features, and outcomes among patients with “happy heart syndrome” (takotsubo syndrome [TTS] provoked by positive life events).
  • Happy heart syndrome is rare (1.5% of all TTS), more commonly seen in men, and more likely to present with atypical nonapical ballooning.
  • Short- and long-term outcomes were similar to patients with “broken heart syndrome."

Study Questions:

What are the frequency, clinical characteristics, and prognostic implications of positive emotional stressors in patients presenting with takotsubo syndrome (TTS)?

Methods:

Patients enrolled in the GEIST (German-Italian-Spanish Takotsubo) registry were categorized according to type of stressor. Patients with pleasant emotional events (“happy heart syndrome”) were compared to those with negative emotional events (“broken heart syndrome”).

Results:

Of 2,482 patients in the registry, 910 patients (36.7%) exhibited an emotional trigger consisting of 873 “broken hearts” (95.9%) and 37 “happy hearts” (4.1%). Consequently, the prevalence of pleasant emotional triggers was 1.5% of all TTS cases. Compared with patients with TTS with negative preceding events, patients with happy heart syndrome were more frequently male (18.9% vs. 5.0%; p < 0.01) and had a higher prevalence of atypical ballooning patterns (27.0% vs. 12.5%; p = 0.01), particularly midventricular ballooning. In-hospital complications, including death, pulmonary edema, cardiogenic shock, or stroke (8.1% vs. 12.3%; p = 0.45), and long-term mortality rates (2.7% vs. 8.8%; p = 0.20) were similar in “happy hearts” and “broken hearts.”

Conclusions:

Happy heart syndrome is a rare type of TTS characterized by a higher prevalence of male patients and atypical nonapical ballooning compared with patients with negative emotional stressors. Despite similar short- and long-term outcomes in this study, additional data are needed to explore whether numerically lower event rates in “happy hearts” would be statistically significant in a larger sample size.

Perspective:

The authors describe prevalence, clinical features, and outcomes among patients with “happy heart syndrome” (takotsubo syndrome provoked by positive life events). Overall prevalence was low and when compared to patients with “broken heart syndrome,” patients were more likely to be male, have atypical nonapical ballooning, and have similar short- and long-term outcomes. Although findings are exploratory and limited by small sample size, they help us better define and understand the enigmatic TTS.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Cardiomyopathies, Heart Failure, Life Style, Patient Outcome Assessment, Prevalence, Pulmonary Edema, Shock, Cardiogenic, Stroke, Takotsubo Cardiomyopathy


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