Thanks to Dr Madias for his instructive comments entitled “could takotsubo syndrome (TS) trigger type 1 myocardial infarction” on our recently published report in the American Journal of Cardiology entitled “A missed penalty kick triggered coronary death in the husband and broken heart syndrome in the wife.” I greatly appreciated Dr Madias awareness of another case, which we regrettably have unnoticed, of TS in an 82-year-old Italian woman watching a football game where the results frustrated and angered the patient who blamed for the loss the Italian national team coach, Marcello Lippi. Kim et al reported that case as “Lippi-induced cardiomyopathy.” Dr Madias has in addition raised an interesting hypothesis, which is whether the acute myocardial infarction in our patient’s husband triggered by the stressful football game followed by a fierce argument has been facilitated by initial TS. Madias proposed that “the disrupted systolic motion of the left ventricular myocardium, with normokinetic/hyperkinetic myocardial territories abutting akinetic myocardial regions, could have led to a rupture of a coronary plaque in the left anterior descending coronary artery and coronary thrombotic occlusion resulting in acute myocardial infarction.” Because of the patient’s critical clinical condition, left ventriculography was not performed during coronary angiography and angioplasty. Nevertheless, echocardiography 13 hours and 2 days after the angioplasty revealed hyopkinesia in the anterior, septal, and apical segments; the contractions in the inferior and lateral wall were normal. Consequently, the left ventricular wall motion abnormality pattern was not consistent with TS in that patient. However, the hypothesis proposed by Madias is appealing and warrants further research. On the other hand, there is evidence and reports that acute coronary syndrome including spontaneous coronary artery dissection (SCAD) may trigger TS. We have recently reported on a series of 20 patients with acute coronary syndrome having left ventricular wall motion abnormality pattern consistent with TS. Postischemic myocardial stunning is actually a form of TS and was the starting point of TS. Madias hypothesis could be interesting in the discussion of the causal link between SCAD and TS. Noteworthy, SCAD and TS afflict predominantly women and both conditions can be induced by an emotional or extreme physical stress factors; thus, for us, an unknown common pathogenesis for both disease entities could be a possibility.