In this report, we describe a case of Tako-Tsubo cardiomyopathy (TTC)--also called 'apical ballooning' syndrome--in which transient left ventricular outflow tract (LVOT) obstruction and mitral regurgitation led to haemodynamic instability. Patients with hypotension should undergo urgent echocardiography to determine if LVOT obstruction is present. This complication has been described in 10-25% of all TTC patients. In patients with hypotension and moderate-to-severe LVOT obstruction, inotropic agents should not be used because they can worsen the degree of obstruction. Instead, it is suggested to use beta-blockers, which can improve haemodynamics by causing resolution of the obstruction. The fact that some patients do not survive their acute TTC event only underscores the importance of prompt recognition and targeted management of dynamic LVOT obstruction.
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