Laughter Is Not The Best Medicine –
The ‘Happy Heart Syndrome’
Takotsubo Syndrome (TTS), or ‘broken heart syndrome’, was first described, in 1990, as a transient weakening of a portion of the heart muscle, resulting in an ‘octopus trap’-like shape of the heart (read: Takotsubo = Octopus trap). Patients with TTS often present like any other patients with ‘heart attacks’ or acute coronary syndromes, but they are found to have no “blockages” in the heart vessels.
TTS is typically precipitated by episodes of severe negative stress such as grief, anger, or fear. These negative emotional triggers have led to the popular term 'broken heart syndrome’.
In my practice as an interventional cardiologist, I have seen many patients presenting with ‘heart attacks’, but in fact have TTS. These TTS patients were typically post-menopausal women, who had sudden chest pains after quarreling with their children or spouses (often, over money matters), or experienced recent bereavement (to most, it is negative emotions like sadness; to some, it’s a celebration or a big relief!)
It is well known that emotional distress may result in an overstimulation of the sympathetic nervous system and/or inappropriate parasympathetic withdrawal. As a consequence, the resulting cardiovascular effects may lead to life threatening arrhythmias, TTS, and even sudden cardiac death.
On the other hand, the role of positive emotions in TTS is far less clear. Positive emotions affect the autonomic nervous system to a similar degree as do negative emotions, which in turn alter heart rate, peripheral vascular resistance, and blood pressure.
The jury is still out on whether positive emotions actually reduce risk of developing cardiovascular disease or can possibly provoke ‘heart attacks’.
Interestingly, the likelihood of experiencing a cardiovascular event on one’s birthday (presumably a positive event, of course) is 27% higher than on any other day of the year.
A recent study in Zurich looked at about 500 patients with TTS in the International Takotsubo Registry. The study analyzed the prevalence and characteristics of TTS in patients after preceding pleasant rather than unpleasant events.
Of the 1750 TTS patients in the registry, the study identified a total of 485 with a definite emotional trigger. Of these, 4.1% presented with pleasant preceding events and 95.9% with unequivocal negative emotional events associated with TTS. Interestingly, clinical presentation of patients with ‘happy heart syndrome’ was similar to those with the ‘broken heart syndrome’ including symptoms such as chest pain. Similarly, electrocardiographic parameters, laboratory findings, and 1-year outcome did not differ.
Our knowledge regarding the involvement of the central nervous system in the pathogenesis of cardiovascular disease remains insufficient. However, ample epidemiological studies have demonstrated that the central nervous system indeed plays a prominent role in cardiovascular disease. Earlier brain imaging studies have revealed activation of specific cortical and subcortical areas of the brain associated with distinct emotional processing, such as extended activation in both temporal lobes during certain emotions including happiness, sadness, and fear, but not during disgust or anger. Subcortical structures including the amygdala, hippocampus, and basal ganglia have also been implicated in emotional processing. The amygdala is not only associated with negative emotions but has been recently also implicated in the processing of pleasant emotions such as happiness.
Presumably, despite their distinct nature, happy and sad life events may share similar final common emotional pathways, which can ultimately trigger TTS.
The ‘broken heart syndrome’ is an established and real medical condition. However, with this study, one cannot refute the existence of the ‘happy heart syndrome’.
Although we still cannot fully understand the mechanisms of the ‘brain-heart’ connection, it would help if one does not get too overly emotional (negatively and/or positively), as now we know that laughter may not be the best medicine.
Expert Author:
Dr Julian K.B. Tan, Cardiologist, The Heart Specialist Clinic
Further Reading
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.