Paradoxical hypoperfusion suggesting early and severe coronary dysfunction in tako-tsubo disease

Tako-tsubo disease (TD) is an unusual and paradigmatic clinical entity of unknown pathophysiology characterized by acute apical dysfunction usually triggered by physical or emotional stress. We describe the case of a woman with TD presenting early myocardial perfusion defects with transient dilatation and systolic dysfunction of left ventricle in gated-SPECT myocardial perfusion imaging, discussing the more likely mechanisms suggested by these functional findings.