Takotsubo cardiomyopathy (also called stress induced cardiomyopathy, apical ballooning, or broken heart syndrome) was first described in Japan 20 years ago.1 It is characterised by acute, reversible left ventricular dysfunction in a characteristic distribution, which does not correlate with the epicardial coronary artery blood supply. The left ventricular dysfunction occurs without obstructive coronary artery disease and usually resolves spontaneously over a period of weeks.

The characteristic appearances seen initially on contrast angiography are a ballooned apical segment and a hypercontractile basal portion of the left ventricle. The appearances are reminiscent of the design of the traditional fishing pot used in Japan to trap octopus, hence the descriptive term “tako-tsubo” cardiomyopathy.

Although this condition was initially considered rare, it could possibly be responsible for 1-2% of admissions for acute coronary syndrome in industrialised countries.2 Apical left ventricular ballooning is the usual pattern, but involvement of the right ventricle or mid and basal left ventricular segments …