Tako-Tsubo cardiomyopathy (TTC), also known as stress inducedcardiomyopathy or apical ballooning syndrome, was first describedby Dote in 1991 [1].Itisdefined as a fully reversible acutedeterioration of left-ventricular function, which is mainly found inwomen after an episode of emotional or physical stress (e.g. psycho-social stress, sepsis, surgery) [2]. The underlying mechanisms remainunclear, although increased catecholamine levels were thought asmain responsible [3,4]. Even less known are the mechanismsunderlying the hyper-acute phase of TTC, which precede apicalballooning and are usually missed because they occur during thepre-hospital phase of the disease. We describe in this case thehyper-acute phase of TTC observed during early in-hospital recur-rence of TTC.A 74-year-old woman, with amyotrophic lateral sclerosis (ALS),referred for pneumonia, after a stressful event during hospitalization,complained of chest pain, with evidence at electrocardiogram of STelevation, negative T-waves in anterior leads, intra-ventricular