Fig. 1.

(A) During the administration of acetylcholine into the left coronary artery, an electrocardiogram (ECG) showed ST-segment elevation in the inferior leads (large arrows), which gradually extended to the precordial leads (small arrows). (B) An ECG performed at the second admission showed T wave inversions with prolonged QT intervals in leads I, II, III, aVF, and V2 to V6. (C) The coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) were 3.9 and 11, respectively, at the time of the initial admission. (D) During apical ballooning, the CFR and IMR values were poorer than those observed during the previous catheterization (i.e. the CFR and IMR values were 2.1 and 16, respectively). (E and F) An echocardiography showed apical hypokinesis with preserved basal function (E, end-diastole; F, end-systole).