Over recent decades, cardiology has evolved into a highly evidence-based specialty. Guided by the results of large, multicentre, randomized trials of patients with common conditions, cardiologists are usually in the happy position of knowing how best to treat patients, once they have been diagnosed with various conditions or are deemed at risk of developing them. This has led to the implementation of standardized approaches to treatment. The progressive uniformity of care has improved outcomes – preserving quality of life and prolonging survival. Arguably, however, cardiologists are now less comfortable in situations of clinical uncertainty, when evidence is inadequate or does not exist to guide decision making. This is well illustrated by the difficulty experienced by many patients in obtaining appropriate care for the cardiac aspects of a neuromuscular disorder. From a patient's perspective, cardiologists seem unfamiliar with their condition and, usually, to favour therapeutic nihilism.