Everybody knows a song or two about heartbreak, the physical reaction to moments of extreme sadness. But according to a report from the BBC, a new study suggests that it’s not only sad feelings that can cause heart distress. Researchers from the University Hospital Zurich in Switzerland have found that moments of joy can lead to similar cardiovascular problems like chest pains and breathlessness.

The study examined takotsubo cardiomyopathy, a stress-induced change in the heart’s left ventricle. In some cases, it could even be fatal.

The study was published in the journal European Heart Journal, and found that roughly one in 20 cases of takotsubo cardiomyopathy are caused by an emotional state induced by joy.

Researchers examined 1,750 different cases, and were shocked by some of the things that caused heart problems in patients. Among other reasons, people suffered heart issues after attending a birthday party, a son’s wedding, meeting a friend after 50 years, a favorite sports team won a game, winning big at the casino, and learning that they were given a clean bill of health with regards to a different diagnosis.

According to Dr. Jelena Ghadri, “We have shown that the triggers for takotsubo syndrome can be more varied than previously thought. A takotsubo syndrome patient is no longer the classic ‘broken-hearted- patient, and the disease can be preceded by positive emotions too.”

The study makes things a little bit trickier for cardiologists treating people with heart problems. It suggests that the heart could be more fragile than researchers once believed, and is susceptible to any change in emotional state, and not just one that leads to negative feelings.

A press release from the European Society of Cardiology describing the study’s details can be found here.