Is the Severity of Takotsubo Cardiomyopathy in Men More Concerning than its Frequent Occurrence in Women?

Abstract

This article addresses the common occurrence of takotsubo cardiomyopathy (also known as broken heart syndrome) in women against the severity of the disease in men. Takotsubo cardiomyopathy is a transient systolic dysfunction of the left ventricle in the absence of any acute coronary syndrome. This condition usually develops after a severe emotional or physical stressor. Symptoms of Takotsubo Syndrome (TTS) typically include severe chest pain, sudden fatigue, dyspnea, light-headedness, and cold sweats. Despite a substantial similarity between the symptoms of TTS and Myocardial Infarction (MI), no blockage of the coronary artery will be detected in angiography in TTS as in MI [1]. Several studies show that TTS is widely seen in postmenopausal females (about 90%) because of emotional stress, including anxiety, panic, financial troubles, and disappointment [1,2]. This is attributed to decreased estrogen levels and increased catecholamine secretion that contribute to its onset. On the other hand, in males, TTS is comparatively less common (about 10%), but more severe and caused mostly by physical stress [2]. Physical stress included cerebrovascular accident, post-operative trauma, acute respiratory failure, and infections. It was noted that men diagnosed with TTS had relatively higher white-blood-cell count, creatine kinase, catecholamine usage, and C-reactive protein than women. Although the difference was not significant. It was reported by the International Takotsubo Registry that 21.1% of males and 14.7% of females had coronary artery disease, and even the mortality rate was higher in males [3]. Unfortunately, men have a greater likelihood of heart failure and developing ventricular arrhythmias and fibrillation, and might require cardiopulmonary supportive therapies. Thus, men have much more critical complications in the acute phase of the TTS than women. TTS is diagnosed by physicians through blood tests, ECG, echocardiogram, and coronary angiogram. Despite the diagnosis, there is no predetermined drug for this condition. However, the use of angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers with beta-blockers showed a improved survival rate [1]. The common occurrence of TTS in women is primarily because of hormonal changes and is manageable due to its uncomplicated nature; however, the severity of handling TTS in men is a clinical challenge worldwide and requires much greater attention. Pakistan Heart Journal is a well-appreciated journal of Pakistan that would benefit from contributions on the gender-based occurrence of takotsubo syndrome, which seems underrepresented in its literature. References Ahmad SA, Brito D, Khalid N, Ibrahim MA. Takotsubo Cardiomyopathy. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 May 22 [updated 2024 Jan]. PMID: 28613735. Natale E, Mistrulli R. Takotsubo syndrome: More frequent in women, more dangerous in men. Eur Heart J Suppl. 2023;25(Suppl_B):B119-B122. DOI: 10.1093/eurheartjsupp/suad089 Murakami T, Komiyama T, Kobayashi H, Ikari Y. Gender Differences in Takotsubo Syndrome. Biology (Basel). 2022;11(5):653. DOI: 10.3390/biology1105065