Transient left ventricular apical ballooning has been recognized as a differential diagnosis of myocardial infarction causing a substantial and ongoing increase of investigations focusing on this topic. Concomitant appearance of transient left ventricular apical ballooning and coronary artery disease has so far not been reported. Here we report on a patient with features very typical for transient left ventricular apical ballooning who angiographically presented also with severe coronary artery disease.