A 48-year-old woman visited the emergency department with shock due to a urinary tract infection. The patient,
who had a history of hypertension and diabetes mellitus, presented with precordial ST-segment elevation and Q
waves, along with an increase of cardiac enzymes. An echocardiography showed moderately reduced systolic function,
severe apical left ventricular ballooning, and a dynamic left ventricular outflow tract obstruction with a
pressure gradient of 109 mmHg. Coronary angiography demonstrated normal coronary arteries. At the 1-month
echocardiographic follow-up, the apical ballooning and left ventricular systolic function had recovered completely.
There was no residual left ventricular intra-cavity gradient at rest, but it was induced in low-dose dobutamine
stress-echocardiography. We demonstrated that dynamic left midventricular obstruction in the setting of
either increased catecholamine stress or hypovolemia could develop Tako-tsubo cardiomyopathy.