The fascinating case of the 76-year-old woman, reported by Y-Hassan [ ], with severe three-vessel coronary artery disease who suffered acute coronary syndrome (ACS) with associated takotsubo syndrome (TTS), reflects the beliefs of the author [ , ], who like others [ ], profess that these 2 conditions often coexist, triggering each other. Indeed this concept is now gradually being accepted by the medical community, and it is even being aknowledged in a recently published consensus document from the ESC [ ]. The ensuing post-ischemic myocardial stunning (PIMS) state, due to the ACS and/or TTS, resulted in transient compression of the left anterior descending artery (LAD), predisposed by LAD myocardial bridging [ ]. A distinction should be made between the speculation about myocardial edema (ME) exerting a compressive effect on the microvasculature in the setting of TTS [ ], and the compression of the epicardial vessels, like the LAD in the present case, which of course depended on the prerequisitive of myocardial bridging [ , ]. The author refers to a “myocardial stunning in TTS, causing a systo-diastolic compression of a segment of the LAD with myocardial bridging, during the sub-acute stage” in his patient, equating this state with a form of “muscle cramps” [ ]; however one wonders whether “myocardial cramps”, should be viewed as a functional manifestation, perhaps like the supercontractility during systole in patients with TTS, mediated by cardiac locally released or blood-borne catecholamines, while the structural/histological state of a myocardial systo-diastolic compression in TTS patients is probably mediated by ME [ , ]. This speculation implies that perhaps early in the clinical course of TTS, a systolic wall hypercontractility phase (“muscle cramps”), precedes the emergence of segmental myocardial akinesis, evident on hospital presentation, something not yet observed. What is encouraging is that many other authors have started to consider that a “takotsubo component” [ ], probably is present in a sizeable proportion (~25%) [ ] of patients presenting with ACS. I look forward to the response of Dr. Y-Hassan on the above.