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

Thomas Stiermaier*, Alexandra Walliser, Ibrahim El-Battrawy, Toni Pätz, Matthias Mezger, Elias Rawish, Mireia Andrés, Manuel Almendro-Delia, Manuel Martinez-Sellés, Aitor Uribarri, Alberto Pérez-Castellanos, Federico Guerra, Giuseppina Novo, Enrica Mariano, Maria Beatrice Musumeci, Luca Arcari, Luca Cacciotti, Roberta Montisci, Ibrahim Akin, Holger ThieleNatale Daniele Brunetti, Ivan J. Núñez-Gil, Francesco Santoro, Ingo Eitel

*Korrespondierende/r Autor/-in für diese Arbeit
15 Zitate (Scopus)


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.

ZeitschriftJACC: Heart Failure
Seiten (von - bis)459-466
PublikationsstatusVeröffentlicht - 07.2022

Strategische Forschungsbereiche und Zentren

  • Zentren: Universitäres Herzzentrum Lübeck (UHZL)


  • 205-12 Kardiologie, Angiologie