**8. Clinical features of the Takotsubo syndrome**

The definitive patient with a primary Takotsubo syndrome would be represented by a postmenopausal woman with experience of an acute, unexpected emotional or physical stress [31]. This bias, however, does not preclude men, younger women and patients with no identifiable trigger from a possible TTS. Consequently, gender, menopausal status and stressful triggers are not mandatory features included in the HFA criteria.

Patients typically present with acute chest pain are consistent with symptoms of angina pectoris, dyspnoea and palpitations. Pre-syncope and syncope due to ventricular tachyarrhythmia, severe left ventricular outflow tract obstruction and cardiogenic shock are more serious manifestations of this syndrome. Non-specific symptoms such as weakness, cough and fever have also been reported [32–34].
