To the EditorWe read with interest the article by Chow et al[1] about a 45-year-old, previously healthy woman who experienced palpitations with T-wave inversions in lead III on a routine electrocardiogram 1 month after the first dose of the Moderna mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Two months after the first dose, she received the second dose; 1 month later, she experienced a first, witnessed, self-limiting, generalized tonic-clonic seizure, which was interpreted as convulsive syncope.[1] Workup for syncope revealed multiple episodes of ventricular tachycardia, runs of sustained ventricular tachycardia lasting up to 8 minutes, and elevated troponin.[1] Endomyocardial biopsy was indicative of myocarditis.[1] Upon initiation of heart failure therapy and steroids, the condition resolved.[1] The study is appealing but raises concerns that require discussion.We disagree that the patient had myocarditis. More likely, she experienced Takotsubo cardiomyopathy (TTC) triggered by a seizure—specifically, the index patents experienced the basal or midventricular subtype of TTC (“reverse TTC”). Arguments in favor of TTC are that epilepsy is frequently complicated by TTC; that TTC mimics myocardial infarction (MI) clinically and blood chemically, electrocardiographically, and echocardiographically; and that myocardial biopsy in TTC patients can mimic myocarditis histologically. Also, several other case reports exist about patients experiencing TTC after a SARS-CoV-2 vaccination, even the reverse type of TTC. Another argument for TTC is that neurologic side effects of SARS-CoV-2 vaccines are more common than cardiologic side effects, supporting the scenario that the reported condition resulted from a seizure-triggered TTC.Inflammatory activation is well documented in TTC.[2] According to the Japanese Circulation Society, many studies of patients with TTC reported the endomyocardial biopsy findings as normal or nonspecific, suspecting myocarditis or myocarditis in the healing stage.[2] Other investigations found infiltration of mononuclear lymphocytes, leukocytes, macrophages in the interstitium, myocardial fibrosis, and contraction bands with or without overt myocyte necrosis in the endomyocardial biopsy specimens,[2] similar to what was found in the index case. Endomyocardial biopsy in patients with TTC may also show macrophages on staining for CD68.[3] In another patient, endomyocardial biopsy revealed hypertrophic bizarre cardiomyocytes with disarray and multiple foci of contraction band necrosis.[4]Seizures are well appreciated as a complication of SARS-CoV-2 vaccinations, but workup for epilepsy in the index patient was incomplete. The family history for epilepsy was not provided. It is unknown if contrast medium was applied when carrying out the cerebral magnetic resonance imaging scan to rule out immune encephalitis, which is increasingly recognized as a potential complication of SARS-CoV-2 vaccinations.[5] No results of cerebrospinal fluid investigations were provided. Also missing is serum creatine-kinase and serum lactate levels after the generalized seizure.[1]Overall, the study, although interesting, has several limitations that challenge the results and their interpretation. Addressing these limitations may increase the value of its conclusions. More likely than myocarditis, the index patient experienced TTC as a complication of a SARS-CoV-2 vaccination.