Background The association with a preceding stressor is a characteristic feature of Takotsubo syndrome (TTS). Negative emotions prior to TTS are common and led to the popular term ‘broken heart syndrome’. In contrast, pleasant triggers (‘happy heart syndrome’) are rare and scarcely investigated. Therefore, we analyzed the frequency, clinical characteristics and prognostic implications of positive emotional stressors in the multicenter GErman-Italian-Spanish Takotsubo (GEIST) Registry.

Methods Patients enrolled in the registry were categorized according to their stressors. This analysis compared patients with pleasant to those 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 to TTS patients with negative preceding events, patients with ‘happy heart syndrome’ were more frequently male (18.9% versus 5.0%; p<0.001) and had a higher prevalence of atypical ballooning patterns (27.0% versus 12.5%; p=0.010). In-hospital complications including death, pulmonary edema, cardiogenic shock, or stroke (8.1% versus 12.3%; p=0.449) and long-term mortality rates (2.7% versus 8.8%; p=0.196) 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, non-apical ballooning compared to cases with negative emotional stressors. Despite similar short- and long-term outcome in our study, additional data are needed to explore whether numerically lower event rates in ‘happy hearts’ turn statistically significant in a larger sample size.