Severe Respiratory Failure and Torsades de Pointes Induced by Disopyramide in a Patient with Myasthenia Gravis

Abstract

Class 1a anti-arrhythmic drugs are often used for the treatment of atrial fibrillation (AF), but it is not well known that myasthenia gravis (MG)- (Fig. 3). Eight hours after hospitalization and thereafter, Torsades de Pointes (TdP) was frequently observed (Fig. 4)

Torsades de Pointes Associated with Takotsubo Cardiomyopathy: Is It Preventable?

“…Most patients were females (n=102; 90.3%). All patients with Takotsubo cardiomyopathy-associated Torsades de Pointes survived, although one patient died of other complications more than two months following Torsades de Pointes (Hirose et al, 2008). Although most patients were females, the prevalence of male gender was significantly higher among patients with Takotsubo cardiomyopathy-associated Torsades de Pointes relative to patients with Takotsubo cardiomyopathy-associated QT interval prolongation (odds ratio 4.6; 95%Cofidence Interval 1.3-16.7).…”

“…Takotsubo cardiomyopathy-associated Torsades de Pointes has been reported in 2005 for the first time (Denney et al, 2005). We have reviewed this case report and additional 14 reports (Akashi et al, 2003;Boulouffe et al, 2007;Finsterer et al, 2007;Furushima et al, 2008;Ghosh et al, 2009;Hirose et al, 2008;Inoue et al, 2009;Kurisu et al, 2008;Mahida et al, 2009;Nault et al, 2007;Okada et al, 2007;Patel et al, 2007;Sasaki et al, 2006) concerning Takotsubo cardiomyopathy-associated Torsades de Pointes in 2009, and we have concluded that males with Takotsubo cardiomyopathy-associated QT interval prolongation are at risk for Takotsubo cardiomyopathy-associated Torsades de Pointes although most patients with Takotsubo cardiomyopathy are females. There has been a trend in the mean maximal QT interval being longer among patients with Takotsubo cardiomyopathy-associated Torsades de Pointes relative to patients with Takotsubo cardiomyopathy-associated QT interval prolongation.…”

Recurrent takotsubo cardiomyopathy precipitated by myasthenic crisis

“…Four cases of takotsubo cardiomyopathy in association with myasthenic gravis have been reported so far [3][4][5][6]. All these were single event episodes as opposed to our index patient who suffered two documented episodes of TTC with the same triggering factor of myasthenic crisis.…”

Torsades de Pointes in Takotsubo Cardiomyopathy with QT Prolongation

“…The presence of QT interval prolongation has been discussed in patients with Takotsubo cardiomyopathy (Abe et al, 2003, Desmet et al, 2003, Matsuoka et al, 2003, and there have been 17 reported cases of QT interval prolongation and torsades de pointes (TdP) associated with Takotsubo cardiomyopathy (Denney et al, 2005, Sasaki et al, 2006, Okada T, et al, 2007in Japanese], Nault et al, 2007, Boulouffe et al, 2007, Patel et al, 2007, Kurisu et al, 2008, Furushima et al, 2008, Hirose et al, 2008, Ghosh et al, 2009, Mahida et al, 2009, Inoue et al, 2009, Kawano et al, 2010, Purvis et al, 2009, Yamada et al, 2011 (Figure 2) (Table 1). Considering the 17 previous cases reported in the literature, QT prolongation in Takotsubo cardiomyopathy has been attributed to hypokalemia (n= 3), bradycardia associated with atrioventricular (AV) block (n=4), idiopathic long QT syndrome (n=2), hypokalemia plus antiarrhythmic therapy (n=1), and hypokalemia plus idiopathic long QT syndrome (n=1), hypokalemia and hypomagnesemia (n=1), hyponagnesemia (n=1), and antibiotic (n=1) in 14 cases, and there was no specific factor associated with QT prolongation in 3 cases.…”