Happy Heart Syndrome: When Joy Becomes a Cardiac Event

Happy Heart Syndrome (HHS), a variant of Takotsubo syndrome (TTS), represents a unique cardiovascular condition triggered by positive rather than negative emotional stressors. This narrative review synthesizes current evidence regarding HHS, which accounts for approximately 4.1% of emotionally-triggered TTS and 1–1.5% of all TTS cases. While sharing clinical presentation similar to the more common negative emotion-triggered TTS (broken heart syndrome), HHS demonstrates distinct characteristics, including a higher male prevalence and more frequent midventricular ballooning patterns. The pathophysiology involves complex interactions between emotional processing, neurohormonal activation, and cardiovascular response, with evidence suggesting different threshold requirements for positive versus negative emotional triggers. Clinical presentation mirrors that of acute myocardial infarction with chest pain, dyspnea, electrocardiographic changes, and elevated cardiac biomarkers, necessitating comprehensive diagnostic workup including coronary angiography, echocardiography, and cardiac magnetic resonance imaging. Although complications such as arrhythmias, ventricular thrombosis, and cardiogenic shock can occur, HHS may be associated with lower rates of in-hospital complications and long- term mortality. Recurrence rates are low, with preventive strategies focusing on emotional regulation and medical optimization. This review highlights the importance of recognizing positive emotional triggers in cardiovascular disease and suggests directions for future research in this emerging field.