Subaortic dynamic obstruction: a contributing factor to haemodynamic instability in tako-tsubo syndrome?

We present a case of transient apical ballooning with haemodynamic instability in a female patient with normal coronaries and a history of poorly controlled systemic arterial hypertension. There was dynamic obstruction of the outflow tract and moderate secondary mitral regurgitation at presentation. These were due to systolic anterior motion of the mitral valve, which normalised gradually with the recovery of left ventricular function, and to a 'sigmoid' septum. Mid-cavity obstruction is potentially an important contributory factor to the haemodynamic instability sometimes encountered in this syndrome.