Graphical Abstract Graphical Abstract Is Takutsubo syndrome (TTS) just the tip of the iceberg? Coronary microvascular dysfunction (CMD) is a prevalent underlying factor in numerous cardiovascular diseases, including ischaemic heart disease, microvascular angina, heart failure with preserved ejection fraction, and TTS. While microvascular angina may represent the most significant clinically evident manifestation of CMD, an acute disruption of dysfuntional mechanisms in an impaired coronary microcirculation—potentially due to external triggers (indicated by the lightning bolt) such as severe stress—provides a suitable explanation for the pathophysiology underlying TTS. Consequently, TTS can be classified as an acute microvascular syndrome.