In postmenopausal women, estrogen reverses acetylcholine-induced coronary arterial vasoconstriction, presumably by improving endothe- lium-dependent coronary vasomotion, and reduces frequency of chest pain.792 However, estrogen is not recommended because of its demonstrated increase in cardiovascular and Spontaneous coronary artery dissection affects a young, predominantly female population. Treatment of spontaneous coronary artery dissection with CABG or stenting is described to improve outcome,794 but high rates of stenting complica- tions are reported.780 7.13. Stress (Takotsubo) Cardiomyopathy: Recommendations Class I 1. Stress (Takotsubo) cardiomyopathy should be con- sidered in patients who present with apparent ACS and nonobstructive CAD at angiography. (Level of Evidence: C) 2. Imaging with ventriculography, echocardiography, or magnetic resonance imaging should be performed to confirm or exclude the diagnosis of stress (Takotsubo) (Level of Evidence: B) 3. Patients should be treated with conventional agents (ACE inhibitors, beta blockers, aspirin, and diuret- ics) as otherwise indicated if hemodynamically sta- ble. (Level of Evidence: C) 4. Anticoagulation should be administered in patients who develop LV thrombi. (Level of Evidence: C) Class IIa 1. It is reasonable to use catecholamines for patients with symptomatic hypotension if outflow tract ob- struction is not present. (Level of Evidence: C) 2. The use of IABP is reasonable for patients with re- fractory shock. (Level of Evidence: C) 3. It is reasonable to use beta blockers and alpha- adrenergic agents in patients with outflow tract obstruction. (Level of Evidence: C) Class IIb 1. Prophylactic anticoagulation may be considered to inhibit the development of LV thrombi. 