Case report: How much pain affects heart? I report a case of a woman 54 yrs old who underwent vertebral artrodesis for a primary cyfoscoliosis of the adult. Echocardiogram done before surgery was normal, no hypertension no metabolic alterations and others factors of cardiac risk. ECG was normal. After the operation pain was 8-9 in the NRS scale. Was done PCA with Morfin associated with paracetamol (1 gr e.v every 6 h ) plus ossicodon 5 mg twice a day with very poor results. 2 days after the ECG demonstrate STsegment elevation in V1 –V2 – V3, the value of troponin Tn I was 1900. A coronarograpy was performed and didn’t show alterations of the coronaries. Ipocynesia of the apex with reduction of ejection fraction at 45 %.The patient was treated with beta- blockers ( metoprolol 100mg twice a day) cardioaspirin (100mg /die)Three days after there was a complete resolution of the pain with normalization of the index of cardiac necrosis. The ECG showed typical aspect of inferoseptal myocardial infarction. Echo cardiogram performed 10 days after showed a partial enhancement of myocardial contractility. We considererd this case typical for Tako tsubo syndrome.