Autonomic imbalance in patients

with takotsubo cardiomyopathy: cause or association? Sir, In a recent paper, Akashi et al.1 examined cardiac autonomic functions in patients with reversible takotsubo cardiomyopathy (TC), and suggested that this disorder might be caused by neurogenic stunning of the myocardium due to acute autonomic dysfunction. While these findings are very interest-ing, and may provide useful insight into the patho-genesis of this poorly understood disorder, certain ethical issues and suggested interpretations of the study deserve attention. In their study, the diagnosis of TC was made based upon acute-onset myocardial-infarction-lik