Severe multivessel coronary vasospasm and left ventricular ballooning syndrome.

In their first description of Takotsubo cardiomyopathy (TC), Dote et al1 hypothesized that the disease was caused by multivessel coronary vasospasm, because 4 of 5 patients in their report had either spontaneous or provocable coronary vasospasm on coronary angiography. However, later studies did not find supporting evidence for the pathogenic role of coronary vasospasm. Recently, the vasospasm hypothesis of TC revived. In a small case series from the United States, Angelini2 was able to provoke severe coronary vasospasm by intracoronary application of acetylcholine in 4 patients with the disease.