Figure 7: Case of 73-year-old man with unknown-cause acute heart failure. Since coronary angiography revealed a >75% stenosis in the mid LAD and a CTO in the first diagonal branch, ischemic heart failure was initially suspected. However, on hybrid SPECT/CT using rest perfusion images with ^99mTc-sestamibi and fatty-acid metabolism images with ¹²³I-BMIPP (non-AC images), anteroapical myocardial damage was not related to either the LAD nor first diagonal branch territory. The diagnosis was eventually confirmed as takotsubo cardiomyopathy.