tako - tsubo cardiomyopathy ( ttc ) is a reversible cardiomyopathy mimicking acute myocardial infarction . it most commonly affects postmenopausal women and is characterized by a transient left ventricular ( lv ) apical ballooning without epicardial coronary artery disease.1 ) it is clinically characterized by acute chest pain or dyspnea in most cases and transient st elevation in the acute phase . the prognosis is generally good.2 ) severe emotional stress is the most common trigger for this syndrome in the published cases , but it can also be precipitated by other possible etiologies . we present a case of a patient with ttc triggered by misdirection while swallowing the drug pills . we report the case of a 67-year - old woman with hypertension and no history of coronary disease hospitalized in the gastro - intestinal department for treatment of severe malnutrition . her past medical history was significant for a total gastrectomy for gastric neoplasia 5 years ago with complete remission . while swallowing the drug pills during hospitalization , she suffered overnight from a misdirection ( false route ) , but due to a hacking cough an inhalation pneumonia was avoided and later she complained of constrictive chest pain . the per - critical electrocardiography ( ecg ) showed sinus rhythm with an anterior st - segment elevation ( fig . 1 ) . a diagnosis of an acute myocardial infarction was made and she was taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention . the coronary angiography demonstrated a non - obstructive coronary atheroma . the lv angiography confirmed an impaired lv systolic function with akinetic mid and apical segments and hyperkinetic basal segments ( fig . an optimal medical treatment including beta - blockers and angiotensin converting enzyme - inhibitors were initiated . the patient evolved well clinically , the ecg normalized with disappearance of ischemic ecg changes and the control cardiac ultrasound at day six showed a total recovery with a normal lv function . ttc , also known as transient lv apical ballooning syndrome or stress - induced cardiomyopathy , is a reversible cardiomyopathy mimicking acute myocardial infarction , usually precipitated by acute physical or emotional stress and most commonly affects postmenopausal women.1 ) the exact physiopathology of ttc remains unclear . catecholamine - mediated cardiotoxicity is the most widely proposed mechanism given that patients typically present with a preceding history of extreme psychological and/or physical distress implying increased sympathetic activity with a direct catecholamine toxic effect on the cardiac myocytes.3)4 ) furthermore , the syndrome is usually self limited and complete recovery can be achieved in two to three weeks . the growing number of clinical cases of ttc have demonstrated a wide field of possible etiologies beyond the emotional stress . we report a case of a 67-year - old postmenopausal woman who was being supplemented by enteral feeding via a nasogastric tube and who developed ttc due to misdirection , probably favored by the mechanical blockade by the nasogastric tube , while swallowing the drug pills . it can be argued that misdirection in predisposed individuals may cause an acute stress resulting in increased sympathetic activity leading to this syndrome . in our patient , another potential causal mechanism could be cough - induced stress cardiomyopathy which has been previously reported.5 )
tako - tsubo cardiomyopathy ( ttc ) , also known as transient left ventricular apical ballooning syndrome or stress - induced cardiomyopathy , is a novel reversible cardiomyopathy mimicking acute myocardial infarction without epicardial coronary artery disease . 
 the exact physiopathology of ttc remains unclear . 
 it is usually precipitated by acute physical or emotional stress and it most commonly affects postmenopausal women . the growing number of clinical cases of ttc have demonstrated a wide field of possible etiologies beyond the emotional stress . 
 we report a case of a 67-year - old postmenopausal woman who was being supplemented by enteral feeding via a nasogastric tube and who developed ttc due to misdirection , probably favored by the mechanical blockade by the nasogastric tube , while swallowing the drug pills .