We thank Drs Alla and Kaushik and Dr Madias for their interest in our case report. Alla and Kaushik ask whether the urine drug screening was done in this patient. As written in the article, we found normal 24-hour urine fractionated catecholamines and metanephrines. This finding makes the use of similar substances unlikely. However, we did not perform any other screening. Nonetheless, we agree that normal screening for substance use should be integrated in the diagnostic criteria of takotsubo cardiomyopathy (TTC). Second, Alla and Kaushik inquire whether this was the first published report of 3 episodes of stress cardiomyopathy in the same patient. We are aware of the presence of recurrent cases ranging …