Comerci Gianluca, Buffon Antonino, Biondi-Zoccai Giuseppe G L, Ramazzotti Vito, Romagnoli Enrico, Savino Marinica, Rebuzzi Antonio G, Biasucci Luigi M, Loperfido Francesco, Crea Filippo
Int J Cardiol. 2005 Sep 1;103(3):335-7. doi: 10.1016/j.ijcard.2004.06.026.
Patients with myasthenia gravis undergo lifelong treatment with anticholinesterase agents. While the heart is usually unaffected by this disease, clinicians should bear in mind the potential adverse interaction between cardiac function and the underlying myasthenic disease or its specific medications. In the present article we report, to the best of our knowledge for the first time in the literature, a case of vasospastic acute myocardial infarction due to iatrogenic hypercholinergic crisis secondary to anticholinesterase therapy in an elderly female with myasthenia gravis. This clinical vignette emphasizes the importance of taking into account the potential vasospastic effect of anticholinesterase drugs. Indeed, prompt recognition of the pathophysiology of myocardial ischemia due to iatrogenic hypercholinergic crisis is pivotal to the timely and appropriate management of this medical emergency, as well as prevention of future recurrences.
重症肌无力患者需终身使用抗胆碱酯酶药物进行治疗。虽然心脏通常不受该疾病影响，但临床医生应牢记心脏功能与潜在的重症肌无力疾病或其特定药物之间可能存在的不良相互作用。在本文中，据我们所知，我们首次在文献中报道了一例患有重症肌无力的老年女性因抗胆碱酯酶治疗继发医源性高胆碱能危象而导致血管痉挛性急性心肌梗死的病例。这个临床案例强调了考虑抗胆碱酯酶药物潜在血管痉挛作用的重要性。事实上，及时认识到医源性高胆碱能危象导致心肌缺血的病理生理学对于及时、恰当地处理这一医疗紧急情况以及预防未来复发至关重要。
