The report by Guerra et al published online ahead of print in the September 5, 2013 issue of The American Journal of Cardiology compares the electrocardiographic (ECG) repolarization changes in 4 sets of electrocardiograms (days 1, 3, 5, and 7) spanning the duration of hospitalization, in 45 patients admitted with Takotsubo syndrome (TTS) and 45 well-matched patients with acute coronary syndrome (ACS). The investigators observed a lower than originally reported rate of ST-segment elevations (+STs), with 60% of their patients presenting with T-wave inversions (↓Ts), which could be a reflection of the rapid conversion of +ST to ↓T, early in the course of illness in patients with TTS, the differences in the selection criteria of the present study and previous works, or the populations studied (Caucasians vs non-Caucasians), as the investigators commented. There is also variation of this study’s findings from previous reports regarding the nonconfirmation of the higher amplitudes of +STs in leads V ₄ to V ₆ than in leads V ₁ to V ₃ , in contrast to patients with an acute anterior +ST myocardial infarction. There are many more reports than the 21 cited in the present study referring to a “dizzying” number of findings and ECG algorithms and formulas to differentiate TTS from ACS. One undisputable finding, that is, the widespread ↓Ts, with persisting prolongation of the QTc, was also confirmed in the present study. However, the investigators did not provide any data confirming the findings of previous reports, about the occurrence of ventricular arrhythmias, in their 45 patients with TTS. On the whole, the investigators conclude that “at least in their population, electrocardiography seems to have limited diagnostic utility in differentiating TTC from ACS” and that “in their opinion, coronary angiography is still mandatory in all patients with suspected TTC as the only reliable diagnostic tool currently available.” This may be true, but we should continue our quest of striving to find a sensitive and specific ECG index that could differentiate TTS and ACS, early after hospital admission, one that could probably even obviate resort to coronary angiography, in a proportion of patients who eventually are diagnosed as having TTS. To this goal, a new ECG insight (transient attenuation of the QRS complexes) has just been reported, with some mechanistic association with myocardial edema, a prominent pathologoanatomic correlate of TTS. The database of the present study provides a marvelous opportunity for the investigators to confirm or disprove this new finding, by comparing measurements of QRS complexes and their course during hospitalization in their 45 patients with TTS and the 45 patients with ACS. In addition, of great importance will be the change in the amplitude of QRS complexes between the first electrocardiograms, recorded on admission, and the corresponding last previous electrocardiograms of their patients with TTS and ACS because 32 of the patients with TTS and 43 of the ones with ACS had a previous electrocardiogram to compare with. Such ECG comparisons will be even easier in the future with the currently accelerating “cloud” computing for ECG data and instant accessibility of previous electrocardiograms of patients, regardless of their geographical acquisition, through computer tablets and smart phones.