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Background  Left ventricular apical ballooning (LVAB) is a type of cardiomyopathy precipitated by emotional or physiological stress, which results in transient left ventricular dysfunction and electrocardiographic (ECG) changes with relatively normal coronary arteries.    Case presentation  We present a case describing the complexity of the diagnosis of LVAB in a patient with cardiovascular risk factors. We also review the literature from the initial discovery of this condition to the new developments.    Conclusion  In patients with cardiovascular risk factors, diagnosis of LVAB is a challenge due to the similarities in symptoms with acute coronary syndrome. Such patients should be managed as an acute coronary syndrome until the definitive diagnosis is made. However, LVAB must still be maintained as a differential diagnosis in those patients to avoid unnecessary therapy.

Diagnostic uncertainty of Takotusbo cardiomyopathy in a woman with cardiovascular risk factors hijacked at gunpoint: a case report