The authors discuss and present transesophageal echocardiographic images of intraoperative tako-tsubo cardiomyopathy in a female patient under general anesthesia. Intraoperative transesophageal echocardiography was performed in an attempt to manage a sudden episode of hypotension and mild pulmonary edema coincidental with surgical incision. The suspected diagnosis of stress cardiomyopathy was confirmed by computed tomographic angiography and cardiac catheterization. The patient made a complete recovery. This case report stresses the utility of transesophageal echocardiography in the differential diagnosis of intraoperative hypotension and suspected acute coronary syndrome.