INTRODUCTION:
Takotsubo cardiomyopathy (TTC), or stress cardiomyopathy, is a reversible left ventricular dysfunction predominantly affecting postmenopausal women, accounting for 80 to 90 % of cases. TTC frequently mimics acute coronary syndrome (ACS), leading to significant diagnostic errors. In postmenopausal women, clinical minimisation often occurs, especially when symptoms are attributed to anxiety or normal stress reactions. These gender disparities, compounded by limited awareness in low and middle income countries, underscore the urgent need for equitable, gender-sensitive cardiovascular care pathways.

METHODS:
A narrative review of literature from 2010 to 2025 was conducted using PubMed, Google Scholar, and major cardiology sources. Search terms included “takotsubo cardiomyopathy,” “postmenopausal women,” “gender disparities,” and “low and middle income countries” to evaluate systemic barriers to equitable cardiovascular care.

RESULTS:
TTC accounts for 1 to 3 % of suspected ACS presentations, with postmenopausal women aged 55 or older disproportionately affected. Oestrogen deficiency and a heightened catecholamine surge in this demographic increase myocardial susceptibility under stress. Overlapping features including chest pain, ST-segment changes, and troponin elevation closely mimic ACS, contributing to diagnostic error. Clinical outcomes include a 6 to 10 % risk of cardiogenic shock and a 1 to 2 % annual recurrence rate among survivors. Inappropriate management remains a challenge for postmenopausal women, particularly in low and middle income settings.

CONCLUSIONS:
Takotsubo cardiomyopathy is a critical consideration in postmenopausal women. High rates of misdiagnosis and clinical minimisation, often manifesting as clinical dismissal, necessitate urgent gender-sensitive care pathways. A global focus on timely and objective recognition, particularly in low and middle income countries, is essential to ensure equitable cardiovascular care and optimise long-term health outcomes for women.