Although some studies suggested that apical ballooning syndrome is independent on the perfusion territory of single coronary artery, the anatomical features of coronary arteries are rarely studies. The subjects were 12 patients (8 women and 4 men, aged 46 to 76 years [median age 61 years) who had presented with transient left ventricular dysfunction shortly after various emotional or physical stresses and were followed with a average duration of 38 months (17-87 months). On coronary angiography, we divided left anterior descending artery (LAD) into two types according as it had a well-developed, long distal recurrent segment supplying a significant area of the inferior left ventricular segment (type A) or not (type B). On admission, clinical presentation included chest pain and dyspnea. Diffuse ST-segment elevation and/or deep T-wave inversion with QTc prolongation occurred in almost all patients. There was no significant coronary artery disease in all patients with one exception; one patient had angiographic evidence of clinically significant coronary disease. Initial left ventricular dysfunction (mean ejection fraction 40%) was completely resolved in all patients (mean ejection fraction 60%, p<0.0001) at 1-2 months. The number of type A patients were significantly higher as compared to type B (9 vs. 3, p<0.01), and there was no right dominance pattern in type A patients (left dominance 6 and co-dominance [balanced] 3). During follow-up, there was no recurrence. We concluded that the anatomical characteristics of coronary arteries such as distribution of LAD and dominance pattern may contribute to apical ballooning syndrome, and these findings should be of practical importance for managing this syndrome.