Pseudoischemic Electrocardiogram in Myasthenia Gravis with Thymoma: Reversibility After Thymectomy

Abstract

Abnormal ST T‐wave changes can be found at presentation in various noncoronary disorders; misinterpretation of these patterns as ischemic heart disease can lead to erroneous diagnosis and treatment. Here we present a case of myasthenia gravis (MG) with thymoma, in which the resting electrocardiogram (ECG) led to a misleading diagnosis of myocardial ischemia. After thymectomy, the ECG resumed a normal pattern. Myasthenia gravis is not usually considered in the differential diagnosis of conditions associated with an abnormal ECG. The combination of dysphagia, dyspnoea, ECG changes, and creatine kinase (CK) elevations may easily bring to mind an erroneous and possibly deleterious diagnosis of myocardial ischemia. Copyright © 2009 Wiley Periodicals, Inc.

(ST segment elevations caused by invasion of carcinoma of the thymus to the myocardium)

“…10 Také byl popsán případ thymomu asociovaného s myasthenia gravis, kdy thymom nebyl v přímém kontaktu se srdcem, na EKG byly změny úseku ST, které po léčbě ustoupily a EKG se normalizovalo. 11 V diagnostice thymomů se uplatňují prostý snímek hrudníku, výpočetní tomografi e (CT) či magnetická rezonance. Pro defi nitivní diagnózu a způsob léčby je potřeba histologické zařazení tumoru, provádí se biopsie transkutánní či transbronchiální cestou nebo při mediastinoskopii.…”

Perioperative cardiac risks in myasthenia gravis

“…He also concluded that antibodies to ganglionic AChRs were responsible for autonomic dysfunction in these patients[ 12 ]. Chiavistelli et al [ 13 ] showed that patients with MG had associated nonspecific changes in T waves, prolongations in QT interval and increase in the incidence of first-degree atrioventricular (AV) block during the perioperative period. Several other studies[ 2 , 14 , 15 ] have documented a positive correlation between anti-Kv1.4 antibody and perioperative fatal arrhythmias, which include sick sinus syndrome, ventricular tachycardias, complete AV block, and sudden cardiac death.…”