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INNOSC Theranostics

and Pharmacological Sciences

REVIEW ARTICLE
A narrative review on gender disparities in the

pathogenesis and pathophysiology of Takotsubo
syndrome: Implications for novel approaches to

treatment?

1
Carola Y. Förster * and Martin J. Herrmann 2
1 Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg
University, Würzburg, Germany
2 Center of Mental Health, Department of Psychiatry and Psychotherapy, University Hospital
Würzburg, Würzburg, Germany

Abstract
Takotsubo syndrome is a type of cardiomyopathy characterized by transient
and reversible left ventricular wall motion abnormalities within the ventricle.
Depending on the severity of the injury, recovery can occur within a few hours or
weeks. According to studies, older people are more likely to be affected by it, and
the prevalence is particularly high among postmenopausal women. Stress factors,
both physical and emotional, are widely discussed and generally recognized as
*Corresponding author: triggers. The hypothalamic-pituitary-adrenal axis and its glucocorticoid-dependent
Carola Y. Förster negative feedback also play important roles in the resulting gender-specific immune
(foerster_c@ukw.de)
response. Transcutaneous vagus nerve stimulation is proposed as a potential novel
Citation: Förster CY, Herrmann MJ. personalized therapeutic strategy in light of the gender disparities in autonomous
A narrative review on gender
disparities in pathogenesis and nervous system activity and inflammatory response. Considering the modifiable risks
pathophysiology of Takotsubo involved in this pathology, such as stress which affects the heart and psychology, a
syndrome: Implications for novel strong emphasis should be placed on preventive medicine. In this paper, we propose
approaches to treatment? INNOSC
Theranostics and Pharmacological the use of non-invasive (transcutaneous) vagus nerve stimulation, as a means of
Sciences. 2024;7(4):3142. dampening sympathetic overdrive with negligible side effects.
doi: 10.36922/itps.3142
Received: March 11, 2024 Keywords: Takotsubo syndrome; Heart-brain; Inflammation; Gender; Central autonomic
Accepted: May 30, 2024 network; Stress
Published Online: September 19,
2024
Copyright: © 2024 This
is an Open-Access article 1. Introduction: the heart–brain axis
distributed under the terms
of the Creative Commons Cardiovascular system regulation is a part of the modulation of the cortical structure
AttributionNoncommercial License, throughout the entire body. Although little is known about the mechanism of the
permitting all non-commercial use, “heart-brain axis,” various cardiac and neurological diseases have been implicated as
distribution, and reproduction in any
medium, provided the original work being influenced by one another. Insular cortex (IC), anterior cingulate gyrus, and
is properly cited. amygdala comprise the cortical modulation network. The central autonomic nervous
Publisher’s Note: AccScience system (CAN) is regulated by this network, for example, in response to physical stimuli
Publishing remains neutral with or emotional stressors like excitement, sadness, or anxiety. Functionally, the IC can be
regard to jurisdictional claims in
published maps and institutional separated into the left insula, which is characterized by the parasympathetic tone and
affiliations. causes the heart rate to drop and the depressor responses to rise, and the right insula,

Volume 7 Issue 4 (2024) 1 doi: 10.36922/itps.3142