Intra-Aortic Balloon Pump Exacerbates Left Ventricular Outflow Tract Obstruction in a Patient With Takotsubo and Hypertrophic Cardiomyopathy

• Obstructive HCM with superimposed takotsubo syndrome led to shock. • The use of an IABP worsened outflow obstruction. • Putting the IABP on standby improved outflow tract gradients dramatically. • An IABP should not be used in shock with LVOT obstruction.