We read with great pleasure the interesting report by Aiman et al. The proposed hypothesis of vasospasm of isolated right-sided coronary arteries is appealing and well possible; however, other relevant considerations should be entertained especially in the absence of objective evidence of vasospasm during coronary angiography. Because the patient was unresponsive, hypotensive, and acidotic, concomitant significant hypoxia is presumably highly likely. Patients with hypoxic respiratory failure or even drug overdose can manifest as transient right ventricular dysfunction and also frequently with biventricular dysfunction.