The symptoms: The woman had been dealing with unexplained chest pain for several months, although earlier tests of her heart health had come back normal. She had stopped attending follow-up appointments regarding the chest pain.
An electrocardiogram (ECG or EKG) showed changes in her heart's electrical activity. This is a sign doctors look for when diagnosing a heart attack, because during the event, blood flow to the heart is impaired and that can injure or kill heart-muscle cells. So, the patient was rushed to a hospital emergency department.
Blood tests showed an elevated level of troponin, a protein that leaks into blood when heart muscle is damaged. An ultrasound of her heart showed that its main pumping chamber, the left ventricle, wasn't squeezing properly; its pumping strength, known as ejection fraction, had dropped from 58% five months earlier to just 35%. (The healthy range is 50% to 70%.) The left ventricle had also ballooned out of shape at the tip.
An X-ray of her heart confirmed the same ballooning shape that was seen on the ultrasound, and an MRI ruled out permanent damage from a silent heart attack or scarring of the tissue.
The condition is thought to be triggered by a sudden surge of stress hormones, such as adrenaline (also called epinephrine), that temporarily stun the heart. The diagnosis was confirmed using the Mayo Clinic's diagnostic criteria, which require ruling out other potential causes, such as heart inflammation (myocarditis), and confirming that there are no significant artery blockages.
The treatment: The woman was treated with standard medications for heart failure medical therapy, such as beta blockers, and discharged once she was stable, with a follow-up scheduled at a heart-failure clinic. She resumed her usual daily activities without limitations, and a follow-up ECG showed that her heart's pumping function had recovered to 56%, close to her original baseline.
An electrocardiogram (ECG or EKG) showed changes in her heart's electrical activity. (Image credit: Getty Images)Takotsubo cardiomyopathy accounts for an estimated 1% to 3% of cases of acute coronary syndromes, an umbrella term for conditions that involve sudden reduced blood flow to the heart. Within that group, the happy heart variant is rarer still. An analysis of the International Takotsubo Registry, which has data from more than 1,700 broken-heart patients around the world, found that positive emotional triggers were behind about 4.1% of emotionally triggered cases. The large majority were tied to grief, fear or other distressing events.
Other dilemmasCompared with the classic symptoms of broken heart syndrome, happy heart syndrome tends to produce a different pattern of heart muscle ballooning that more often affects the middle or base of the heart in addition to the tip. That alternate pattern was not seen in this case, though.
This article is for informational purposes only and is not meant to offer medical advice.
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