Background: Stress-induced cardiomyopathy (SCMP) is an increasingly recognized disease entity. As various triggering events were associated with SCMP, we sought to evaluate the clinical outcomes of this potentially fatal disease in a tertiary referral hospital. Methods: Diagnostic criteria of SCMP included newly developed wall motion abnormalities on echocardiography without clinical evidence of coronary artery disease, which includes normal coronary angiogram or perfusion scan. Patients with either typical apical ballooning or atypical ballooning (or akinesia) of basal or mid ventricle were included. Results: A total of 59 patients were diagnosed to have SCMP from Jan 2000 to June 2008. Women comprised 78% of total patients and the median age was 63 years (29-85). The triggering events were severe physical illness (sepsis, hypoxemia, bleeding, etc) in 31 patients (52%), in-hospital procedure (endoscopy, bronchoscopy, elective surgery, etc) in 17 (29%) and emotional stress (severe quarrel, sudden death of family member, etc) in 11 (19%). Mean ejection fraction was 34짹9% and typical apical ballooning was present in 45 patients (76%); right ventricular involvement was observed in 11 (19%). T wave inversion was the most frequently observed ECG finding (n=43, 73%) and ST segment elevation was present in 14 (24%). Tachyarrhythmia (atrial fibrillation [n=7], atrial flutter [n=2], and ventricular tachycardia [n=3]) was observed in 12 patients (20%). Forty eight patients (81%) needed intensive care, largely due to pulmonary edema (n= 30, 51%) and shock (n= 21, 35%). APACHE II score, a measure of systemic illness, was lower in purely emotional stress group than in physical illness or in-hospital procedure group (median 16 vs. 11, p=0.029). In-hospital death occurred in 9 patients (15%) and multivariate analysis showed that APACHE II score (HR 1.246, 95% CI 1.044 - 1.487, p=0.015) and right ventricular involvement (HR 8.292, 95% CI 1.220 – 56.360, p=0.031) were independent predictors. Conclusions: SCMP frequently occurs during treatment of underlying illness or diagnostic procedures in a tertiary referral hospital. Physicians��� vigilance for early detection of SCMP is needed.