Diagnostic dilemma: A joyful wedding nearly broke a woman's heart in a rare case of 'happy heart syndrome'

The patient: A 65-year-old woman in Qatar 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.

But then, she experienced three days of chest pain and shortness of breath that got worse with activity.

The symptoms, which began shortly after she attended her daughter’s wedding, initially brought her to a clinic, according to a report of the case .

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.

What happened next: By the time the patient reached the emergency room, her chest pain had eased, but a repeat ECG showed different electrical abnormalities from the local clinic.

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.

Doctors performed an angiogram , a test that uses a thin tube and dye to check for blocked arteries, and found that her arteries were clear.

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 diagnosis: Doctors diagnosed the patient with takotsubo cardiomyopathy , also known as stress cardiomyopathy or " broken heart syndrome ." The condition temporarily weakens the heart muscle and causes it to balloon, producing symptoms that closely resemble a heart attack.

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.