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There are times when medical professionals should stay away from using the Greek name for a condition. For instance, you might reasonably think "so I'm gonna die then" if a doctor told you you had sphenopalatine ganglioneuralgia, before you're told that's the medical term for brain freeze.
With one very specific condition we would argue the opposite. No doctor, consultant, or surgeon should be telling people they have "happy heart syndrome" if they want to get across the seriousness of the condition. In a new case report, doctors have documented how one woman came to have the condition, after seeing her daughter get married.
You have likely heard of the inverse (but related) condition often referred to as "broken heart syndrome" (BHS); a sudden weakness in your heart muscles following severe emotional or physical stress, for example the loss of a loved one, or following an argument, or financial stress.
“[It’s] a condition called takotsubo cardiomyopathy, where a sudden shock or grief causes heart failure and you die from that,” Philip Lee, consultant physician in acute medicine and medicine for the elderly, explained to IFLScience. “Basically, too much noradrenaline [or] adrenaline, and the bottom of your heart stops pumping properly.”
The condition is a tricky one for medical practitioners to deal with, closely mimicking acute coronary syndrome in terms of symptoms (including chest pain) as well as clinical markers seen electrocardiographically, and in other medical tests, though it is its own distinct condition.
"Takotsubo syndrome (TTS), also known as stress cardiomyopathy or ‘broken heart syndrome,’ is characterized by transient left ventricular systolic dysfunction in the absence of obstructive coronary artery disease," the case report explains.
Unfortunately, despite being transient, it isn't risk-free, with the chance of patients developing sudden cardiac arrest following traumatic events.
While TTS following a negative event, such as the death of a loved one, is rare, the inverse is even rarer. But it is possible to cause the same kind of stress on your heart with positive emotions.
"Positive emotions can result not only in increased activation of the sympathetic nervous system but also in increased parasympathetic nervous system activity," a previous case report explains, adding, quite unnecessarily, "interestingly, the likelihood of experiencing a cardiovascular event on one's birthday is 27% higher than on any other day of the year."
So happy it hurts
In the new case report, the team describes how a 65-year-old woman sought treatment after suffering chest pain for three days following her daughter's wedding. On top of the pain, the woman – who was already an outpatient due to pain in the months prior to this incident – was experiencing shortness of breath, which became worse during exercise.
A series of urgent tests confirmed there was no obstructive coronary artery disease present in the patient, nor pheochromocytoma or myocarditis. The team was able to rule out a number of other causes too, finding little other than an enlarged and weakened ("ballooning") left ventricle, which was deemed to be suggestive of TTS.
The team writes that prior to the event she had experienced "overwhelming happiness" at seeing her daughter getting married. When TTS occurs following a positive emotion or event, it is known as happy heart syndrome (HHS). While a nice name, in terms of seriousness, it would be like calling acute renal failure "puppy kidneys" or saying "whimsical liver" in place of viral hepatitis.
While it was certainly a rollercoaster for the mother of the bride, she thankfully recovered well and showed improved heart function at a follow-up appointment.
"Unfortunately, this overwhelming happiness was followed days later by the onset of HHS," the team writes in their report. "Despite the initially alarming presentation, she achieved complete cardiac recovery and continues to live healthily, looking forward to witnessing the happiest milestones of her other children in the years ahead."
Intriguingly, the two types of this condition differ slightly in their effect on the heart.
"HHS is more frequently associated with mid-ventricular or basal ballooning rather than the classic apical pattern of BHS, and may also present with less severe symptoms and better short-term outcomes, though further data are needed," the team explains.
With the broken heart syndrome being relatively rare, representing around 1–2 percent of all suspected acute coronary syndrome incidents, and happy heart syndrome being an even rarer subset of that, there is statistically little for you to worry about.
But cases like this help inform other medical practitioners of diagnoses to consider when faced with particular symptoms and presentations. In this case, they highlight that happy heart syndrome should be considered to avoid unnecessary interventions and potential risk to patients, though given its rarity it can often be overlooked.
The case report is published in Oxford Medical Case Reports.
