Some 25 years ago, Japanese researchers identified a rare, sudden, and temporary heart-weakening condition that can be triggered by an intensely stressful and emotionally negative event — one that engenders deep feelings of anger, fear or grief.
They called this condition takotsubo cardiomyopathy, or takotsubo syndrome (TTS), because it appears to cause the heart’s left ventricle — the organ’s main pumping chamber — to swell into a shape that resembles a takotsubo, a ceramic pot used traditionally in Japan as an octopus trap.
In the media and among the public, however, the condition is more commonly known as “broken heart syndrome,” primarily because of its association with tales of elderly people who die of a sudden heart attack within hours of learning about the death of their spouse.
That epithet may need to change. For late last week, an international team of researchers reported in the European Heart Journal that TTS may also be triggered — albeit in even rarer cases — by sudden and intense positive emotions, such as those experienced while attending a child’s wedding, becoming a grandparent or celebrating a birthday or retirement.
In other words, some TTS episodes might be better described under the moniker “happy heart syndrome.”
For the current study, researchers used the International Takotsubo Registry, which has been collecting data since 2011 on people with TTS from 25 hospitals in eight European countries and the United States. Between 2011 and 2014, the registry recorded 1,750 cases of TTS, of which 485 developed following an emotional event.
The researchers analyzed that data further and determined that while an overwhelming majority of those cases — 465, or 95.9 percent — were linked to a specific negative emotional event, a few — 20, or 4.1 percent — had been preceded by an intensively pleasant emotional event.
Events in the study thought responsible for “happy heart syndrome” included attending a son’s wedding, meeting with friends from high school after 50 years, winning several jackpots at a casino, becoming a great grandmother, having a positive job interview, and being the focus of a joyful birthday celebration.
That link between TTS and birthday celebrations is particularly interesting, the researchers point out, because of another study that found people are 27 percent more likely to have a heart attack or stroke on their birthday than on any other day of the year.
Events in the study thought responsible for “broken heart syndrome” fell primarily under the headings of grief/loss, panic/fear/anxiety and interpersonal conflicts. They included the death of a spouse or other loved one, an automobile or other type of accident, a robbery or burglary, a family problem, and a house damaged by fire or flood.
The TTS symptoms of people with both “happy heart syndrome” and “broken heart syndrome” were similar, primarily chest pain and shortness of breath. In both groups, 95 percent of the people were women, mostly in their mid to late 60s, a finding that supports other research that has found TTS occurs mainly among older women.
The study did find one possible significant difference between the two trigger groups: “Happy heart” patients were more likely than “broken heart” ones to experience a ballooning of their heart’s mid-ventricle (35 percent versus 16 percent). The researchers do not know why.
TTS can lead to fatal heart arrhythmias, stroke and heart failure, but such deaths are extremely rare. Indeed, in this study only about 1 percent of the patients died — and none were among those with “happy heart syndrome.”
Limitations and implications
The current study has several limitations. To begin with, it is an observational study, which means it cannot prove that any emotional event — positive or negative — directly causes people’s hearts to suddenly weaken. Also, the number of patients who experienced TTS after a happy event was very small. For the phenomenon to be confirmed, much larger numbers of cases would need to be found.
The study’s authors, however, believe it is time to expand the colloquial definition of TTS.
“We have shown that the triggers for TTS can be more varied than previously thought,” said Dr. Jelena Ghadri, a resident cardiologist at the University Hospital Zurich and an author of the study, in a released statement. “A TTS patient is no longer the classic ‘broken hearted’ patient, and the disease can be preceded by positive emotions too. … Our findings broaden the clinical spectrum of TTS.”
Ghadri and her colleagues stress that much more research is needed to understand exactly why an intensely emotional event — either positive or negative — can trigger a TTS episode in some people.
In the meantime, however, keep these findings in perspective, and don’t use them to cancel birthday or other joyful celebrations.
As reviewers of the study for the National Health Service in Great Britain emphasize: “These findings should not be taken as a reason to not enjoy positive emotional events. TTS is rare and usually reversible, so there is no real need for concern.”
FMI: You can download and read the study in full at the European Heart Journal website.