December 9, 2010 by staff
Myasthenia Gravis, IntroductionMyasthenia gravis is a neuromuscular junction postsynaptic autoimmune disease. Myasthenic crisis is characterized by respiratory failure requiring mechanical ventilation.
Takotsubo cardiomyopathy is a rare clinical syndrome defined as a profound but reversible dysfunction of the left ventricle in the absence of the report of coronary artery presentationWe disease.Case a unique case of a 60 year old woman with myasthenia gravis who developed Hispanic Takotsubo cardiomyopathy and concomitant myasthenic crisis appear to have been triggered by a stressful life event. On admission, she presented with severe chest pain mid-sternal and shortness of breath shortly after a stressful personal life important.
A neurological examination showed bilateral facial weakness and relevant ptosis. Left ventriculography showed apical ballooning with hyperdynamic proximal segments with preservation of the apex.
His troponin I level was high, while cardiac catheterization revealed no significant coronary artery disease. The results are consistent with Takotsubo cardiomyopathy.
Shortly after cardiac catheterization, she developed bilateral INO and significant bulbar weakness and respiratory muscles. FVC values were consistently less than 1 L.
The patient developed respiratory failure and required endotracheal intubation. After treatment with corticosteroids and plasmapheresis, the clinical course improved with extubation success.
A normal sized left ventricular chamber and a normal ejection fraction were identified by an echocardiogram repeated 10 months later.
Conclusion: This is the first reported case of the simultaneous triggering of both Takotsubo cardiomyopathy, and myasthenic crisis by the physiological consequences of a state of emotional stress. We hypothesize that the mechanism underlying the association with Takotsubo cardiomyopathy rare myasthenic crisis involves excessive release of endogenous glucocorticoids, a state of high catecholamines, or a combination of both.
We recommend careful monitoring of cardiac patients with myasthenia gravis in an acute physical or emotional stress, because there is potential risk of developing cardiomyopathy Takotsubo.
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