Takotsubo cardiomyopathy is an acute reversible form of cardiac failure, firstly described in 1991, with a prognosis not favorable as previously thought. Although high levels of catecholamines have been suggested as the leading mechanism for the onset, the pathophysiology remains unclear. However, several pathophysiological explanations have been proposed, all not mutually exclusive. A complex chain of events is present, including the activation of the hypothalamic-pituitary-adrenal axis, the surge in circulating catecholamines and subsequent cardiovascular responses. This review addresses the diagnostic classification, short and mid-term prognosis, precipitating factors, classification into primary and secondary forms, and possible drug therapies for stress cardiomyopathy. Clinical and experimental studies are needed to further improve diagnosis and targeted therapies.