Reply: complexity of assessment and management of Tako-Tsubo cardiomyopathy.

compared with inotropic agents, to prevent the development of significant intraventricular gradients and subsequent hemodynamic deterioration. A word of caution should be added—in patients with cardiogenic shock associated with LVOTO, inotropic agents, vasodilators, and diuretic agents, as well as intraaortic balloon counterpulsation may lead to worsening of shock and worse outcomes (4–6). Balloon deflation further accelerates the blood flow across the LVOT, thereby increasing systolic negative pressure in the aorta and LVOT pressure gradients (5,6).