Stress from myasthenic crisis triggers Takotsubo (broken heart) syndrome

Finsterer, Josef; Stöllberger, Claudia

doi:10.1016/j.ijcard.2015.11.005

Cited by 18 publications

(13 citation statements)

References 16 publications

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“…Stress cardiomyopathy is a well-known complication associated with neurointensive care patients with subarachnoid hemorrhage, stroke, traumatic brain injury, and status epilepticus [ 8 ]. Rarely, certain neuromuscular junction disorders like myasthenia crisis also precipitate SC probably secondary to increased levels of circulating catecholamines [ 3 – 6 , 9 ]. The commonest form is apical ballooning syndrome characterized by apical and mid wall akinesis and hypercontractile basal left ventricular segments [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Myasthenia patients may have other coexisting autoimmune diseases like thyroiditis and polymyositis which can impact their disease course and treatment [ 2 ]. Myasthenia crisis patients may have high levels of circulating catecholamines due to physical and emotional stress, which can cause stress-induced cardiomyopathy [ 3 – 6 ]. There have been several case reports of patients developing Takotsubo stress cardiomyopathy (SC) with left ventricular (LV) dysfunction during myasthenia crisis but its recurrence is rare [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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A Case Report of Recurrent Takotsubo Cardiomyopathy in a Patient during Myasthenia Crisis

Battineni

Mullaguri

Thanki

et al. 2017

Case Reports in Critical Care

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Introduction Patients with myasthenia crisis can develop Takotsubo stress cardiomyopathy (SC) due to emotional or physical stress and high level of circulating catecholamines. We report a patient who developed recurrent Takotsubo cardiomyopathy during myasthenia crisis. Coexisting autoimmune disorders known to precipitate stress cardiomyopathy like Grave's disease need to be evaluated. Case Report A 69-year-old female with seropositive myasthenia gravis (MG), Grave's disease, and coronary artery disease on monthly infusion of intravenous immunoglobulin (IVIG), prednisone, pyridostigmine, and methimazole presented with shortness of breath and chest pain. Electrocardiogram (ECG) showed ST elevation in anterolateral leads with troponemia. Coronary angiogram was unremarkable for occlusive coronary disease with left ventriculogram showing reduced wall motion with apical and mid left ventricle (LV) hypokinesis suggestive of Takotsubo stress cardiomyopathy. Her symptoms were attributed to MG crisis. Her symptoms, ECG, and echocardiographic findings resolved after five cycles of plasma exchange (PLEX). She had another similar episode one year later during myasthenia crisis with subsequent resolution in 10 days after PLEX. Conclusion Takotsubo cardiomyopathy can be one of the manifestations of myasthenia crisis with or without coexisting Grave's disease. These patients might benefit from meticulous fluid status and cardiac monitoring while administering rescue treatments like IVIG and PLEX.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Case Report of Recurrent Takotsubo Cardiomyopathy in a Patient during Myasthenia Crisis

Battineni

Mullaguri

Thanki

et al. 2017

Case Reports in Critical Care

View full text Add to dashboard Cite

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“…TTS as a result of a myasthenic crisis can be circumvented by avoiding stress, which can be achieved by careful management of these patients. In cases of acute cardiac manifestations in patients with myasthenia, TTS must be excluded …”

Section: Crisismentioning

confidence: 99%

Management of myasthenia gravis in daily practice for general neurologists and healthcare professionals

Yokoyama

2017

Clinical & Exp Neuroim

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A characteristic feature of myasthenia gravis (MG) is the fluctuating weakness of the muscles. MG is an autoimmune neuromuscular junction disorder mediated by autoantibodies against nicotinic acetylcholine receptor and muscle-specific tyrosine kinase. If the commercially available acetylcholine receptor and muscle-specific tyrosine kinase antibody test is negative, MG patients are termed as having double-seronegative MG. Although the clinical phenotype is not yet defined, antibodies for lipoprotein receptor-related protein 4 and agrin, involved in clustering of acetylcholine receptors within the postsynaptic membrane and in structural maintenance of the neuromuscular synapse, have been found. The updated 2014 Guidelines in Japan state that the management of MG should be individualized, and earlier aggressive treatment using steroid pulse, plasma exchange and intravenous immunoglobulin therapy, before long-term steroid therapy, should be used in order to minimize manifestation, with fewer adverse effects achieved by co-administering immunosuppressants. In 2016, thymectomy was shown to be efficacious in non-thymomatous MG in a single-arm randomized clinical trial. The continuous update and modification in MG management makes it difficult for the general neurologist to decide on a treatment strategy. The present review aims to improve the understanding of current MG diagnosis, specific immunotherapy and clinical management tips, not only for the general neurologist, but also for other medical staff.

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“…6 Several cases of Takotsubo cardiomyopathy have been reported in association with myasthenic crisis in the literature, and the mortality rate is $17%. 46,47…”

Section: Complicationsmentioning

confidence: 99%

Getting Rid of Weakness in the ICU: An Updated Approach to the Acute Management of Myasthenia Gravis and Guillain-Barré Syndrome

2016

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After prompt diagnosis, severe myasthenia gravis and Guillain-Barré syndrome (GBS) usually require management in the intensive care unit. In the myasthenic patient, recognition of precipitating factors is paramount, and frequent monitoring of bulbar, upper airway, and/or respiratory muscle strength is needed to identify impending myasthenic crisis. Noninvasive ventilation can be attempted prior to intubation and mechanical ventilation in the setting of respiratory failure. Cholinesterase inhibitors should be discontinued, but resumed prior to extubation, and steroid dosage could be increased once the airway is secured. In GBS, hemodynamic and respiratory monitoring are essential; however, respiratory failure can develop rapidly and intubation with mechanical ventilation is often required and can be prolonged. Guillain-Barré syndrome can also be complicated by dysautonomia necessitating specific therapies. Prompt recognition and initiation of immunotherapy including intravenous immunoglobulin or plasmapheresis, together with supportive care including treatment of underlying infections and physical therapy, can improve outcomes in both myasthenic crisis and GBS.

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Stress from myasthenic crisis triggers Takotsubo (broken heart) syndrome

Cited by 18 publications

References 16 publications

A Case Report of Recurrent Takotsubo Cardiomyopathy in a Patient during Myasthenia Crisis

A Case Report of Recurrent Takotsubo Cardiomyopathy in a Patient during Myasthenia Crisis

Management of myasthenia gravis in daily practice for general neurologists and healthcare professionals

Getting Rid of Weakness in the ICU: An Updated Approach to the Acute Management of Myasthenia Gravis and Guillain-Barré Syndrome

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