Tetanus is a life-threatening nervous disorder, which is now a rare condition in the developed world, thanks to effective immunization programmes and proper treatment of wounds and traumatic injuries. The generalized form, which consists of muscle spasms and autonomic dysfunction is the most common and most severe clinical form. We describe the case of a patient in whom generalized tetanus was diagnosed and successfully treated. The autonomic features are described and are accompanied by tako-tsubo cardiomyopathy, a form of heart failure which is caused by adrenergic stimuli. © 2011, Nederlandse Vereniging voor Intensive Care. All Rights Reserved.