Happy Heart Syndrome: Takotsubo syndrome may be triggered by happy events also

The authors analyzed positive emotional stressors' frequency, clinical characteristics, and prognostic implications in the multicenter GEIST (GErman-Italian-Spanish Takotsubo) Registry. The association with a preceding stressor is a characteristic feature of takotsubo syndrome (TTS). Negative emotions before TTS are common and led to the popular term "broken heart syndrome." In contrast, pleasant triggers ("happy heart syndrome") are rare and are scarcely investigated. Patients enrolled in the registry were categorized according to their stressors. This analysis compared patients with pleasant emotional events with patients with negative emotional events.

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."

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

Reference:

Happy Heart Syndrome: Frequency, Characteristics, and Outcome of Takotsubo Syndrome Triggered by Positive Life Events by Thomas Stiermaier et al. published in the JACC: Heart Failure.

DOI: 10.1016/j.jchf.2022.02.015