Happy heart syndrome: role of positive emotional stress in takotsubo syndrome

Jelena R. Ghadri, Annahita Sarcon, Johanna Diekmann, Dana Roxana Bataiosu, Victoria L. Cammann, Stjepan Jurisic, Lars Christian Napp, Milosz Jaguszewski, Frank Scherff, Peter Brugger, Lutz Jäncke, Burkhardt Seifert, Jeroen J. Bax, Frank Ruschitzka, Thomas F. Lüscher, Christian Templin, Moritz Schwyzer, Jennifer Franke, Hugo A. Katus, Christof Burgdorf, Heribert Schunkert, Holger Thiele, Johann Bauersachs, Carsten Tschöpe, Lawrence Rajan, Guido Michels, Roman Pfister, Christian Ukena, Michael Böhm, Raimund Erbel, Alessandro Cuneo, Karl-Heinz Kuck, Claudius Jacobshagen, Gerd Hasenfuß, Mahir Karakas, Wolfgang Koenig, Wolfgang Rottbauer, Samir M. Said, Ruediger C. Braun-Dullaeus, Florim Cuculi, Adrian Banning, Thomas A. Fischer, Tuija Vasankari, K.E. Juhani Airaksinen, Marcin Fijalkowski, Andrzej Rynkiewicz, Grzegorz Opolski, Rafal Dworakowski, Philip MacCarthy, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Filippo Crea, Wolfgang Dichtl, Wolfgang M. Franz, Klaus Empen, Stephan B. Felix, Clément Delmas, Olivier Lairez, Paul Erne, Abhiram Prasad

Takotsubo syndrome (TTS) is typically provoked by negative stressors such as grief, anger, or fear leading to the popular term 'broken heart syndrome'. However, the role of positive emotions triggering TTS remains unclear. The aim of the present study was to analyse the prevalence and characteristics of patients with TTS following pleasant events, which are distinct from the stressful or undesirable episodes commonly triggering TTS. Takotsubo syndrome patients with preceding pleasant events were compared to those with negative emotional triggers from the International Takotsubo Registry. Of 1750 TTS patients, we identified a total of 485 with a definite emotional trigger. Of these, 4.1% (n = 20) presented with pleasant preceding events and 95.9% (n = 465) with unequivocal negative emotional events associated with TTS. Interestingly, clinical presentation of patients with 'happy heart syndrome' was similar to those with the 'broken heart syndrome' including symptoms such as chest pain [89.5% (17/19) vs. 90.2% (412/457), P = 1.0]. Similarly, electrocardiographic parameters, laboratory findings, and 1-year outcome did not differ. However, in a post hoc analysis, a disproportionate higher prevalence of midventricular involvement was noted in 'happy hearts' compared with 'broken hearts' (35.0 vs. 16.3%, P = 0.030). Our data illustrate that TTS can be triggered by not only negative but also positive life events. While patient characteristics were similar between groups, the midventricular TTS type was more prevalent among the 'happy hearts' than among the 'broken hearts'. Presumably, despite their distinct nature, happy and sad life events may share similar final common emotional pathways, which can ultimately trigger TTS.