Cardiac autonomic control in patients with myasthenia gravis and thymoma

Perić, Stojan; Rakočević-Stojanović, Vidosava; Nisic, Tanja; Pavlović, Sanja; Basta, Ivana; Popovic, Srdjan; Damjanović, Svetozar; Lavrnić, Dragana

doi:10.1016/j.jns.2011.05.028

Cited by 27 publications

(30 citation statements)

References 19 publications

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“…9 There was no significant difference in parasympathetic function. Peric et al, 10 found similar results in 21 patients with the standard cardiovascular reflex test. In our case autonomic instability was severe and prolonged complicating the management of the patient.…”

Section: Discussionmentioning

confidence: 65%

Pitfalls in the Ventilator Management of Myasthenia Gravis: Autonomic Instability and Anticholinesterase-Induced Airway Resistance

Rk¹,

Mishra²,

Sarma³

et al. 2017

MOJCR

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Section: Discussionmentioning

confidence: 65%

Pitfalls in the Ventilator Management of Myasthenia Gravis: Autonomic Instability and Anticholinesterase-Induced Airway Resistance

Rk¹,

Mishra²,

Sarma³

et al. 2017

MOJCR

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“…Confounding the catecholaminergic-mediated myocardial dysfunction of TC are the catecholamine-mediated changes in coronary vascular tone and the parasympathetic dysfunction seen in MC. The autonomic changes of MC are characterized by parasympathetic dysfunction, with lowered parasympathetic excitatory postsynaptic potentials suspected to be secondary to damage and blockade from the nicotinic anti-AChR on postsynaptic ganglion AChR [14,15]. Elevated circulating levels of catecholamines from the physical stress of MC compounded with blunted parasympathetic innervation enables dramatic sympathetic and adrenergic tone on the coronary vasculature, both on the epicardial vessels and microcirculatory system.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy Mimicking Myocardial Infarction in a Man with Myasthenic Crisis: A Case Report and Literature Review

Douglas

Wengrofsky

Haseeb

et al. 2018

AJMCR

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Takotsubo Cardiomyopathy is a syndrome characterized by transient and reversible regional myocardial dysfunction in the absence of obstructive coronary artery disease classically resulting in ventricular apical ballooning. It has a strong female predominance with onset generally in seventh decade of life, with hypothesized pathophysiology related to excess of catecholaminergic stimulation, particularly during episodes of physical or emotional stress. Takotsubo cardiomyopathy has been previously reported during myasthenic crisis, the acute deterioration of myasthenia gravis typically involving respiratory failure that is also associated with physical or emotional stress. We present the case of an atypically young male patient with classical takotsubo cardiomyopathy in the setting of myasthenic crisis after thymectomy initially concerning for ST segment elevation myocardial infarction, and a review of the literature of takotsubo cardiomyopathy in myasthenic crisis.

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“…However, whether these antibodies may impair the ability of epinephrine to bind to β 2 -adrenergic receptors and facilitate bronchospasm remains unclear. Moreover, abnormalities in cardiac autonomic control [9] and ganglionic AchR-Ab [10] have been reported in subsets of patients with MG, suggesting there may be an imbalance between sympathetic and parasympathetic neural regulation in some patients with MG. Such an imbalance may facilitate a chronic increase in airway smooth muscle tone.…”

Section: Discussionmentioning

confidence: 99%

Asthma as a Cause of Persistent Dyspnea in Treated Myasthenia Gravis Patients

Echaniz‐Laguna

Pistea²,

Philippi³

et al. 2012

Eur Neurol

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Aims: The aim of this study was to evaluate the proportion of patients with treated myasthenia gravis (MG) who present with dyspnea not related to MG. Methods: We analyzed the files of 63 consecutive adult patients with treated MG and persistent dyspnea who had been referred to our Pulmonary Function Test (PFT) Department between 2000 and 2010. Results: We observed that asthma was the first cause of MG-unrelated dyspnea in MG patients, with 9 patients (14%) presenting with asthma-related PFT abnormalities. Six patients had asthma for several years before developing MG, and 3 patients (4%) developed asthma a few months after MG was diagnosed, suggesting a non-coincidental association between the two conditions. In all 3 cases, asthma appeared in elderly patients with severe late-onset AchR-Ab- positive MG, treated with pyridostigmine and corticosteroids and/or intravenous immunoglobulins. In all 3 patients, β₂-adrenergic agonist treatment allowed only partial control of dyspnea. In one case, respiratory symptoms were alleviated when pyridostigmine dosage was reduced. Conclusions: Patients with treated MG and persistent dyspnea should be investigated for asthma using PFT before being diagnosed with refractory MG. If asthma is diagnosed, a bronchodilator treatment should be instituted and a reduction in pyridostigmine dosage should be proposed.

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Cardiac autonomic control in patients with myasthenia gravis and thymoma

Cited by 27 publications

References 19 publications

Pitfalls in the Ventilator Management of Myasthenia Gravis: Autonomic Instability and Anticholinesterase-Induced Airway Resistance

Pitfalls in the Ventilator Management of Myasthenia Gravis: Autonomic Instability and Anticholinesterase-Induced Airway Resistance

Takotsubo Cardiomyopathy Mimicking Myocardial Infarction in a Man with Myasthenic Crisis: A Case Report and Literature Review

Asthma as a Cause of Persistent Dyspnea in Treated Myasthenia Gravis Patients

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