eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2019-06-11 7 6 109 116 10.12691/ajmcr-7-6-4 AJMCR2019764 article Philip Tulio 1 Jehad Azar jehad.azar@gmail.com 1 Keyvan Ravakhah 2 Randol Kennedy 2 Vasant Temull 2 Internal Medicine Resident, St. Vincent Charity Medical Center, Cleveland, USA Chairman of Internal Medicine, St. Vincent Charity Medical center, Cleveland, USA Stress (Takotsubo) cardiomyopathy (CM) is defined as a transient regional systolic dysfunction of the left ventricle that mimics acute coronary syndrome (ACS) in the absence of significant coronary artery disease or plaque rupture. This phenomenon commonly occurs in postmenopausal females in the presence of emotional, physical and psychological stressors with excess catecholamine stimulation, resulting in diffuse microvascular spasm and subsequently myocardial stunning. Here we report a 58-year-old postmenopausal female patient with end stage renal disease (ESRD) who was presented to our hospital with a clinical picture suggesting ACS. Shortly after admission she progressed to cardiogenic shock and pulseless electrical activity (PEA) and was diagnosed retrospectively with Takotsubo cardiomyopathy. She was successfully treated with beta-blockers, IV fluids and inotropic agents. Intra-aortic balloon pump (IABP) was considered, however, the patient gradually improved to full recovery with resolution of left ventricular function back to normal. http://pubs.sciepub.com/ajmcr/7/6/4/ajmcr-7-6-4.pdf Takotsubo stress cardiomyopathy arrhythmia cardiogenic shock Intra-aortic balloon pump Left ventricular outflow tract obstruction