Features of Takotsubo Syndrome in Male Patients

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Takotsubo syndrome has particular significance among heart diseases, as with the increase in the number of publications, there is more and more evidence that this syndrome can cause serious complications and even death of patients. Similarity with acute coronary syndrome is even more important reason for interest in Takotsubo syndrome, coupled with the lack of a clear diagnostic criterion to distinguish these pathologies. The lack of understanding of the pathogenesis of Takotsubo syndrome is one of the obstacles to the formation of such a diagnostic criterion. Despite a large number of publications on the causes and pathogenesis of Takotsubo syndrome, course of the disease has not been studied in men, since this pathology is much more often observed in women. Identifying the gender characteristics of this disease and their causes can be an important step towards explaining the pathogenesis of Takotsubo syndrome. In this review, a sample of 45 clinical cases of Takotsubo syndrome in men was compared with a mixed group from a clinical study. Takotsubo syndrome in men has a number of distinctive features: the greater importance of physical stress in the structure of the causes, in contrast to the predominance of emotional stress in the mixed group, a higher proportion of the basal form of the disease, as well as a significant decrease in the ejection fraction of the left ventricle and the frequent occurrence of cardiogenic shock manifestations of a more severe course of this disease.

Full Text

Restricted Access

About the authors

Tat’yana E. Karaoglanova

I.M. Sechenov First Moscow State Medical University (Sechenovskiy University)

Author for correspondence.
Email: t.e.kar@mail.ru
ORCID iD: 0000-0002-6547-1394
SPIN-code: 5577-7982

MD, PhD, Associate Professor

Russian Federation, Moscow

Aleksey V. Manzyuk

I.M. Sechenov First Moscow State Medical University (Sechenovskiy University)

Email: aleksej-manzyuk@yandex.ru
ORCID iD: 0000-0003-4087-3351
SPIN-code: 9044-6712


Russian Federation, Moscow


  1. Medeiros K, O’Connor MJ, Baicu CF, et al. Systolic and diastolic mechanics in stress cardiomyopathy. Circulation. 2014;129(16):1659–1667. doi: https://doi.org/10.1161/CIRCULATIONAHA.113.002781
  2. Templin С, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015;373(10):929–938. doi: https://doi.org/10.1056/NEJMoa1406761
  3. Nef HM, Mollmann H, Akashi YJ, Hamm CW. Mechanisms of stress (Takotsubo) cardiomyopathy. Nat Rev Cardiol. 2010;7(4):187–193. doi: https://doi.org/10.1038/nrcardio.2010.16
  4. Neil CJ, Nguyen TH, Singh K, et al. Relation of delayed recovery of myocardial function after takotsubo cardiomyopathy to subsequent quality of life. Am J Cardiol. 2015;115(8):1085–1089. doi: https://doi.org/10.1016/j.amjcard.2015.01.541
  5. Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008;118(25):2754–2762. doi: https://doi.org/10.1161/CIRCULATIONAHA.108.767012
  6. Akashi YJ, Nef HM, Lyon AR. Epidemiology and pathophysiology of Takotsubo syndrome. Nat Rev Cardiol. 2015;12(7):387–397. doi: https://doi.org/10.1038/nrcardio.2015.39
  7. Zhang L, Wu S, Ruan Y, et al. Testosterone suppresses oxidative stress via androgen receptor-independent pathway in murine cardiomyocytes. Mol Med Rep. 2011;4(6):1183–1188. doi: https://doi.org/10.3892/mmr.2011.539
  8. Kato K, Lyon AR, Ghadri JR, Templin C. Takotsubo syndrome: aetiology, presentation and treatment. Heart. 2017;103(18):1461–1469. doi: https://doi.org/10.1136/heartjnl-2016-309783
  9. Arias-Loza PA, Muehlfelder M, Pelzer T. Estrogen and estrogen receptors in cardiovascular oxidative stress. Pflügers Arch. 2013;465(5):739–746. doi: https://doi.org/10.1007/s00424-013-1247-7
  10. Kuo BT, Choubey R, Novaro GM. Reduced estrogen in menopause may predispose women to takotsubo cardiomyopathy. Gender Medicine. 2010;7(1):71–77. doi: https://doi.org/10.1016/j.genm.2010.01.006
  11. Khera R, Light-McGroary K, Zahr F, et al. Trends in hospitalization for takotsubo cardiomyopathy in the United States. Am Heart J. 2016;172:53–63. doi: https://doi.org/10.1016/j.ahj.2015.10.022
  12. Sengupta S, Mungulmare K, Wadaskar N, Pande A. Inverted Takotsubo cardiomyopathy after attempted suicidal hanging-two cases. Indian Heart J. 2016;68(Suppl 1):S52–S56. doi: https://doi.org/10.1016/j.ihj.2015.06.042
  13. Cattaneo M, Moccetti M, Pasotti E, et al. Three Recurrent Episodes of Apical-Ballooning Takotsubo Cardiomyopathy in a Man. Circulation. 2015;132(24):e377–е379. doi: https://doi.org/10.1161/CIRCULATIONAHA.115.017630
  14. Чукаева И.И., Орлова Н.В., Карселадзе Н.Д., и др. Клинический случай стрессиндуцированной кардиомиопатии такоцубо // Медицинский алфавит. – 2018. – Т. 1. – №12. – С. 44–47. [Chukaeva II, Orlova NV, Karseladze ND, et al. Clinical case of stress-induced takotsubo cardiomyopathy. Medical alphabet. 2018;1(12):44–47. (In Russ.)]
  15. Cesário V, Loureiro MJ, Pereira H. Miocardiopatia de takotsubo num serviço de Cardiologia [Takotsubo cardiomyopathy in a cardiology department]. Rev Port Cardiol. 2012;31(9):603–608. doi: https://doi.org/10.1016/j.repc.2012.01.018
  16. Blanc P, Jaussaud J, Douard H. A rare form of midventricular Tako Tsubo cardiomyopathy. Ann Cardiol Angeiol (Paris). 2010;59(1):31–33. doi: https://doi.org/10.1016/j.ancard.2009.09.011
  17. Grubisha M, Gopalan P, Azzam PN. Takotsubo cardiomyopathy in a young man after maintenance electroconvulsive therapy and clozapine initiation: a case report. J ECT. 2014;30(4):e40–e41. doi: https://doi.org/10.1097/YCT.0000000000000111
  18. Brabham WW, Lewis GF, Bonnema DD, et al. Takotsubo cardiomyopathy in a patient with previously undiagnosed hypertrophic cardiomyopathy with obstruction. Cardiovasc Revasc Med. 2011;12(1):70.e1–70.e705. doi: https://doi.org/10.1016/j.carrev.2010.09.007
  19. Fijalkowski M, Fijalkowska M, Nowak R, Rynkiewicz A. Takotsubo cardiomyopathy in a male during a Euro 2012 football match. Clin Res Cardiol. 2013;102(4):319–321. doi: https://doi.org/10.1007/s00392-013-0536-7
  20. Doucet KM, Labinaz MX, Beauchesne LM, Burwash IG. Cardiogenic shock in Takotsubo cardiomyopathy: a focus on management. Can J Cardiol. 2015;31(1):84–87. doi: https://doi.org/10.1016/j.cjca.2014.09.025
  21. Traullé S, Kubala M, Jarry G, et al. Tako-Tsubo syndrome following status epilepticus. Neurol India. 2011;59(3):480–482. doi: https://doi.org/10.4103/0028-3886.82759
  22. Kaoukis A, Panagopoulou V, Mojibian HR, Jacoby D. Reverse Takotsubo cardiomyopathy associated with the consumption of an energy drink. Circulation. 2012;125(12):1584–1585. doi: https://doi.org/10.1161/CIRCULATIONAHA.111.057505
  23. Medved S, Ostojić Z, Jurin H, Medved V. Takotsubo cardiomyopathy after the first electroconvulsive therapy regardless of adjuvant beta-blocker use: a case report and literature review. Croat Med J. 2018;59(6):307–312. doi: https://doi.org/10.3325/cmj.2018.59.307
  24. Savall F, Dedouit F, Telmon N, Rouge D. Takotsubo cardiomyopathy in a jeweler following a hold-up: forensic considerations. Journal of Forensic Sciences. 2013;58(6):1648–1650. doi: https://doi.org/10.1111/1556-4029.12207
  25. Сердюков Д.Ю., Барсуков А.В., Балабанов А.С., и др. Случай атипичной формы синдрома такоцубо у молодого мужчины // Ультразвуковая и функциональная диагностика. — 2017. — № 5. — С. 78–85. [Serdyukov DYu, Barsukov AV, Balabanov AS, et al. Clinical case of takotsubo syndrome atypical form in young male. Ultrasonic and functional diagnostics. 2017;(5):78–85. (In Russ.)]
  26. Alexandre J, Benouda L, Champ-Rigot L, Labombarda F. Takotsubo cardiomyopathy triggered by alcohol withdrawal. Drug and Alcohol Review. 2011;30(4):434–437. doi: https://doi.org/10.1111/j.1465-3362.2011.00289.x
  27. Rodriguez-Castro CE, Saifuddin F, Porres-Aguilar M, et al. Reverse takotsubo cardiomyopathy with use of male enhancers. Proc (Bayl Univ Med Cent). 2015;28(1):78–80. doi: https://doi.org/10.1080/08998280.2015.11929197
  28. Christensen TE, Ahtarovski KA, Andersson H, et al. Takotsubo-cardiomyopathy: a case of extremely fast recovery described by multimodality cardiac imaging. Journal of Nuclear Cardiology. 2012;19(6):1240–1242. doi: https://doi.org/10.1007/s12350-012-9620-z
  29. Daniels DV, Fearon WF. The index of microcirculatory resistance (IMR) in takotsubo cardiomyopathy. Catheterization and Cardiovascular Interventions. 2011;77(1):128–131. doi: https://doi.org/10.1002/ccd.22599
  30. Daly MJ, Dixon LJ. Takotsubo cardiomyopathy in two preoperative patients with pain. Anesthesia and analgesia. 2010;110(3):708–711. doi: https://doi.org/10.1213/ane.0b013e3181a96fb9
  31. Von Knobelsdorff-Brenkenhoff F, Abdel-Aty H, Schulz-Menger J. Takotsubo cardiomyopathy after nasal application of epinephrine--a magnetic resonance study. Int J Cardiol. 2010;145(2):308–309. doi: https://doi.org/10.1016/j.ijcard.2009.10.044
  32. Cacciotti L, Camastra GS, Musarò S, et al. Stress cardiomyopathy: transient basal ballooning. J Cardiovasc Med (Hagerstown). 2010;11(10):764–767. doi: https://doi.org/10.2459/JCM.0b013e328334466c
  33. Haynor J, Colombo C, Javaheri S. A novel approach to the diagnosis of stress-induced cardiomyopathy. J Am Osteopath Assoc. 2012;112(11):743–747.
  34. Hjalmarsson C, Oras J, Redfors B. A case of intracerebral hemorrhage and apical ballooning: An important differential diagnosis in ST-segment elevation. Int J Cardiol. 2015;186:90–92. doi: https://doi.org/10.1016/j.ijcard.2015.03.187
  35. Benali Zel A, Abdedaim H, Omari D. Liver contusion in man reveals a Tako-tsubo cardiomyopathy without chest pain: reality or illusion? Pan Afr Med J. 2014;17:176. doi: https://doi.org/10.11604/pamj.2014.17.176.3461
  36. Yu SH, Su HM, Lin TH, et al. Acute cardiogenic pulmonary edema induced by severe hypoglycemia — a rare case report. Int J Cardiol. 2013;168(3):e94–e95. doi: https://doi.org/10.1016/j.ijcard.2013.07.122
  37. Thompson AG, Hung J. Takotsubo cardiomyopathy associated with alcohol withdrawal. Med J Aust. 2011;194(7):373. doi: https://doi.org/10.5694/j.1326-5377.2011.tb03015.x
  38. Homorodean C, Ober MC, Olinic M, et al. Takotsubo Cardiomyopathy presenting as ST-elevation myocardial infarction: wide triggering spectrum and specific echocardiographical pattern in a consecutive case series report. Med Ultrason. 2016;18(4):475–480. doi: https://doi.org/10.11152/mu-876
  39. Lemesle F, Lemesle F, Nicola W, Pierre Jonville-Béra A. First case of stress cardiomyopathy as a result of methadone withdrawal secondary to drug-drug interaction. Am J Emerg Med. 2010;28(3):387.e5–е6. doi: https://doi.org/10.1016/j.ajem.2009.07.007
  40. Miyake K, Funatsu T, Kondoh H, Taniguchi K. Rare Complication of Takotsubo Cardiomyopathy: Ventricular Septal Perforation with Septal Dissection. J Card Surg. 2016;31(3):150–153. doi: https://doi.org/10.1111/jocs.12676
  41. Moller C, Graf T, Stiermaier T, et al. Classical apical ballooning with significant stenosis of the left anterior descending coronary artery: is cardiac magnetic resonance imaging the solution for this diagnostic dilemma? Clin Res Cardiol. 2016;105(7):632–635. doi: https://doi.org/10.1007/s00392-016-0974-0
  42. Brunetti ND, De Gennaro L, Correale M, Pellegrino PL, Cuculo A, Di Biase M. Les liaisons dangereuses: Tako-Tsubo syndrome after an adulterous intercourse in an elderly male. Int J Cardiol. 2011;149(3):e113–e117. doi: https://doi.org/10.1016/j.ijcard.2009.05.059
  43. Gerbaud E, Jaussaud J, Lederlin M, Réant P. Transient left ventricular non-apical ballooning syndrome: Diagnosis with multiple imaging modalities. Arch Cardiovasc Dis. 2010;103(4):270–272. doi: https://doi.org/10.1016/j.acvd.2009.08.013
  44. Scheiba N, Viedt-Suelmann C, Schäkel K. Tako-tsubo cardiomyopathy after a hymenoptera sting and treatment with catecholamines. Acta Derm Venereol. 2011;91(5):593–594. doi: https://doi.org/10.2340/00015555-1119
  45. Grander W, Schwaiger J, Seeber J, Dünser MW. Cyber war — when virtual fear of death turns into a real threat of life. Int J Cardiol. 2011;149(1):e16–e17. doi: https://doi.org/10.1016/j.ijcard.2009.03.031
  46. Dores H, Raposo L, Ferreira J, Andrade MJ, Almeida M, Mendes M. Apical ballooning syndrome during diagnostic coronary angiography. Arq Bras Cardiol. 2013;100(4):e47–e50. doi: https://doi.org/10.5935/abc.20130082
  47. Madias JE. Thrombosis in a right wrap around coronary artery leading to takotsubo syndrome phenotype diagnosed as an acute myocardial infarction: Lingering afterthoughts. Int J Cardiol. 2016;220:534. doi: https://doi.org/10.1016/j.ijcard.2016.06.291
  48. Kamada T, Hayashi M, Yokoi H, et al. Takotsubo cardiomyopathy with involvement of delayed-onset rhabdomyolysis and acute kidney injury after rosuvastatin treatment. Intern Med. 2015;54(1):31–35. doi: https://doi.org/10.2169/internalmedicine.54.3239
  49. Fulcher J, Wilcox I. Basal stress cardiomyopathy induced by exogenous catecholamines in younger adults. Int J Cardiol. 2013;168(6):e158–160. doi: https://doi.org/10.1016/j.ijcard.2013.08.067
  50. Diletti R, Dominici M, Patella MM, et al. ST-elevation during surgery in a young male: who would bet on inverted takotsubo syndrome? Int J Cardiol. 2012;162(1):e6–е7. doi: https://doi.org/10.1016/j.ijcard.2012.04.118
  51. Y-Hassan S. Cardiac rupture in a patient with Takotsubo syndrome triggered by acute myocardial infarction: two messages. Int J Cardiol. 2014;177(1):162–165. doi: https://doi.org/10.1016/j.ijcard.2014.09.108
  52. Fineschi M, D’Ascenzi F, Sirbu V, Mondillo S, Pierli C. The role of optical coherence tomography in clarifying the mechanisms for dobutamine stress echocardiography-induced takotsubo cardiomyopathy. Echocardiography. 2013;30(5):E121–E124. doi: https://doi.org/10.1111/echo.12107
  53. Cecconi A, Franco E, de Agustín JA, et al. Hyponatremia-induced stress cardiomyopathy due to psychogenic polydipsia. Int J Cardiol. 2016;202:618–620. doi: https://doi.org/10.1016/j.ijcard.2015.09.123
  54. Van Rensburg A, Kyriakakis C. A tale of a cobra and an octopus: Takotsubo cardiomyopathy following a snake bite. Am J Med. 2015;128(4):e5–e6. doi: https://doi.org/10.1016/j.amjmed.2014.10.045
  55. Bartoli CR, Nadar MM, Loyd GE, Kasdan ML. An atypical case of reverse Takotsubo cardiomyopathy during general anesthesia in a 30-year-old male with post-traumatic stress disorder. J Cardiothorac Vasc Anesth. 2011;25(6):1116–1118. doi: https://doi.org/10.1053/j.jvca.2010.09.025
  56. Saiful FB, Lafferty J, Jun CH, et al. Takotsubo cardiomyopathy due to iatrogenic methadone withdrawal. Rev Cardiovasc Med. 2011;12(3):164–167. doi: https://doi.org/10.3909/ricm0600
  57. Scally C, Abbas H, Ahearn T, et al. Myocardial and Systemic Inflammation in Acute Stress-Induced (Takotsubo) Cardiomyopathy. Circulation. 2019;139(13):1581–1592. doi: https://doi.org/10.1161/CIRCULATIONAHA.118.037975
  58. Madhavan M, Prasad A. Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis. Herz. 2010;35(4):240–243. doi: https://doi.org/10.1007/s00059-010-3339-x
  59. Shin DG, Cho IJ, Shim CY, et al. Transient apical wall thickening in patients with stress cardiomyopathy: prevalence, profile, and impact on clinical course. Int J Cardiol. 2015;194:87–92. doi: https://doi.org/10.1016/j.ijcard.2015.05.101

Supplementary files

There are no supplementary files to display.

Copyright (c) 2020 "Paediatrician" Publishers LLC

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies