Tako-tsubo syndrome (TTS) is a rare disorder characterized by reversible apical left ventricular ballooning usually triggered by an emotional and/or physical stress and often mimicking an acute myocardial infarction. We describe a case of 78 year old woman with TTS associated with hypovolemia and hyponatraemia. The hypovolemic state could have activated the sympathetic system and in turn catecolamine overload with consequent myocardial stunning.