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A 61-year-old woman with severe rheumatic mitral stenosis underwent successful balloon mitral valvotomy (single inflation up to 24 mL with a 26 mL balloon; Shenzhen Shineyard Medical Device, China). One hour after the procedure, she developed severe angina. On examination, she had a varying pulse and normal blood pressure. Preprocedure ECG (figure 1A) had shown first degree atrioventricular block. During the angina attack, the ECG showed new onset atrial flutter, varying atrioventricular blocks, ST segment depression and deeply inverted T waves in leads II, III, aVF and …

Takotsubo cardiomyopathy following balloon mitral valvotomy