Tatkotsubo cardiomyopathy is a transientt cardiomyopathy of unknown origin due to left ventricular apical ballooning. Although first described in Japanese patients, it is now diagnosed worldwide. The syndrome mimics acute ST-elevation myocardial infarction in the absence of significant epicardial coronary artery disease. Although significant efforts have been made to understand it, the pathophysiology of takotsubo cardiomyopathy remains poorly understood. We hypothesize that takotsubo cardiomyopathy may be considered a metabolic form of cardiomyopathy characterized by dysfunctional metabolism of cardiomyocytes. Evidence to support this hypothesis is given possible therapeutic implications are discussed.