An unexpected sequel to happiness: happy heart syndrome

Takotsubo cardiomyopathy (TCM) is characterized by transient regional systolic dysfunction without obstructive coronary artery disease. A rare subtype, happy heart syndrome (HHS), is triggered by positive emotional events. A 65-year-old woman with hypertension, diabetes mellitus, and dyslipidemia presented with typical anginal chest pain for three days, beginning after attending a wedding party. Initial clinic ECG showed anterolateral ST-segment elevation, prompting referral to the Emergency Department. On arrival, her chest pain had resolved, and repeated ECG demonstrated normalization of ST changes with QT prolongation and T-wave inversion. Troponin was elevated at 717 ng/l. Echocardiography showed an EF of 35% (baseline 58%) with apical and LAD-territory akinesia and ballooning. Coronary angiography revealed normal coronaries, while left ventricular angiography demonstrated findings consistent with TCM. Cardiac MRI excluded infarction or fibrosis. With guideline-directed therapy, EF recovered to 56% on follow-up.