Background: Presentation of Takotsubo cardiomyopathy (TCM) widely varies amongst the patients, ranging from asymptomatic patients to cardiogenic shock or even cardiac arrest. The underlying risk factors inherent to the patient that predispose to a catastrophic presentation have not been delineated well in the past. Objective: To distinguish risk factors and presenting characteristics of patients diagnosed with cardiogenic shock from TCM. Methods Total 51 angiography-confirmed TCM patients admitted in Upstate Hospital from 2010 – 2014 were compared retrospectively, 13 presenting with cardiogenic shock. Results While TCM was predominantly common in elderly females, four of the total six male TCM patients presented with shock (Odds ratio= 8.0, p=0.027). TSH was higher in cardiogenic shock group. Patients with shock had significantly higher incidence of ST elevations on EKG and higher peak troponins. Moreover, ST elevations were predominantly in the inferior, anteroseptal and lateral leads in the shock group as compared to only the septal leads in the control group. Echocardiography revealed lower LV ejection fraction, LV outflow tract obstruction and concomitant significant mitral regurgitation in shock patients. No correlation was found with age, BMI, coronary disease risk factors (diabetes, hypertension, smoking), coincident infection, electrolyte imbalance, QTc interval length. Conclusions Risk factors and pathophysiology for cardiogenic shock in TCM were identified. TCM in males is rare, but male gender is a risk factor for shock.