Management
Since acute coronary syndrome is often suspected before the diagnoses of TC is made, initial treatment is often similar to that for an acute MI. However, after the diagnosis of TC is confirmed, treatment is supportive with monitoring and treatment of complications,such as acute heart failure, left ventricular outflow tract obstruction, mitral regurgitation, hypotension, arrhythmias and thromboembolism. There are no randomised trial data to direct therapy. Initiation of beta-blocker therapy is recommended given the potential pathophysiological role of catecholamines, and the treatment is continued long term with the goal of preventing recurrence. However, it is worth noting that retrospective studies have shown that TC can occur in patients who are prescribed beta-blockers raising doubt over their efficacy in this condition.15 Treatment with a renin-angiotensin system antagonist should also be considered until there is spontaneous recovery of left ventricular function, which typically occurs over 4–6 weeks. If coincidental coronary artery disease is detected, secondary prevention measures should be initiated. Screening for acute or chronic emotional stress and psychiatric disorders is important and interventions may be reasonable in some cases.
Prognosis
The vast majority of patients with TC have good prognosis with complete resolution of systolic dysfunction. In-hospital mortality from early studies was estimated at approximately 2 %.16 Higher in-hospital mortality of 4.2 % has recently been reported from the National Inpatient Sample database in the US.17 In a meta-analysis of 37 case series with a total of 2,120 patients from 11 countries, the in-hospital mortality rate was 4.5 %. Thirty-eight percent of deaths were directly related to TC complications, but the rest were due to underlying non-cardiac conditions.18 This highlights the fact that acute morbidity related to complications such as pulmonary oedema, cardiogenic shock and arrhythmias can be significant.Among those who have complete recovery, long-term survival appears to be similar to the age- and gender-matched population.16 In another study, there was increased mortality in TC patients compared with age- and gender- matched controls in the first year after the index event, but all the deaths in this case series were non-cardiac, mostly due to cancer.15 In one of the longest follow-ups available to date of patients with TC, recurrence of the condition was observed in approximately 10 % of patients over a mean follow-up duration of 4 years.16