Fig. 1.

Recurrent Tako-tsubo syndrome (TTS) in a woman with coronary artery fibromuscular dysplasia and left ventricular apical infarction. a (right anterior oblique caudal projection) and (b) (right anterior oblique cranial projection): The coronary angiograms showing a tapering and smooth narrowing (with a discrete transition from normal to diseased artery) in distal left anterior descending artery (arrows) .c The Ventriculography (right anterior oblique projection) demonstrating apical ballooning involving broader myocardium beyond the territory of distal LAD (arrowheads). d Non-contrast cardiac magnetic resonance (CMR) images indicating dilated left ventricle (arrow). e Two chamber view contrast CMR with late gadolinium enhancement (LGE) image revealing localized inferoapical myocardial infarction (arrowhead). f Short-axis view contrast CMR with LGE image revealing localized inferoapical apical myocardial infarction (arrowhead). g-o Recurrent TTS with alternated ventricular contractile patterns. g, h, i Two dimensional echocardiograms; (j, k, l): Three-dimensional echocardiograms; M,N,O: Speckle tracking echocardiograms (automated function imaging with a “bull’s eye” plot). g, j, and m: Initial TTS; (h), (k) and (n): recovery period; (i), (l), and (o): recurrent TTS