Elsevier

JACC: Heart Failure

Volume 10, Issue 7, July 2022, Pages 459-466
JACC: Heart Failure

Clinical Research
Happy Heart Syndrome: Frequency, Characteristics, and Outcome of Takotsubo Syndrome Triggered by Positive Life Events

https://doi.org/10.1016/j.jchf.2022.02.015Get rights and content
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Abstract

Background

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.

Objectives

The authors analyzed the frequency, clinical characteristics, and prognostic implications of positive emotional stressors in the multicenter GEIST (GErman-Italian-Spanish Takotsubo) Registry.

Methods

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.”

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 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. (GErman-Italian-Spanish Takotsubo Registry [GEIST Registry]; NCT04361994)

Key Words

broken heart syndrome
happy heart syndrome
outcome
takotsubo syndrome (TTS)

Abbreviations and Acronyms

LV
left ventricular
TTS
takotsubo syndrome

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The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs Santoro and Eitel contributed equally to this work.