title: Happy heart syndrome: role of positive emotional stress in takotsubo syndrome.
abstract: 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.
authors.forename: Jelena R
authors.initials: JR
authors.lastname: Ghadri
authors.forename: Annahita
authors.initials: A
authors.lastname: Sarcon
authors.forename: Johanna
authors.initials: J
authors.lastname: Diekmann
authors.forename: Dana Roxana
authors.initials: DR
authors.lastname: Bataiosu
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Cammann
authors.forename: Stjepan
authors.initials: S
authors.lastname: Jurisic
authors.forename: Lars Christian
authors.initials: LC
authors.lastname: Napp
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Frank
authors.initials: F
authors.lastname: Scherff
authors.forename: Peter
authors.initials: P
authors.lastname: Brugger
authors.forename: Lutz
authors.initials: L
authors.lastname: Jäncke
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
mesh_terms: D004562:Electrocardiography; D006321:Heart; D006801:Humans; D013315:Stress, Psychological; D013577:Syndrome; D054549:Takotsubo Cardiomyopathy
keywords: Acute heart failure; Brain–heart connection; Broken heart syndrome; Takotsubo syndrome