A 63-year-old woman with hypertension presented with chest pain after an argument with her spouse. On arrival, her ECG disclosed ST-segment elevations in the precordial leads with elevated cardiac enzymes. The patient had a prompt transthoracic echocardiogram (TTE), which demonstrated systolic dysfunction with apical ballooning (arrows in Figure, A). Subsequent contrast enhancement of her TTE displayed a paucity of contrast in the apex, thereby signifying perfusion defects in that region (arrows in Figure, D). The patient then underwent emergent cardiac catheterization, which failed to demonstrate coronary artery disease (left coronary artery shown in Figure, F) but did confirm moderate systolic dysfunction with apical ballooning (Figure, C). The patient was medically managed and discharged in stable condition, with follow-up at 3 weeks demonstrating nearly total recovery of cardiac function; the estimated ejection fraction quantified this recovery by increasing from 42% to 56% (Figure, B). Her repeated contrast TTE showed enhancement of the apex consistent with improved perfusion (arrows in Figure, E). Her clinical presentation is consistent with that of Takotsubo cardiomyopathy (Japanese for octopus catcher), a syndrome associated with elderly women often in emotional distress that is characterized by transient apical regional wall motion abnormalities in the absence of epicardial coronary artery disease. Perfusion deficits seen on these contrast TTE images support the hypothesis that Takotsubo cardiomyopathy may be intimately associated with microvascular dysfunction.