Said Sarmad, Cooper Chad J, Alkhateeb Haider, Elhanafi Sherif, Bizet Jorge, Gosavi Sucheta, Abedin Zainul
Department of Internal Medicine, Paul L. Foster School of Medicine,Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
Am J Case Rep. 2013 Sep 11;14:359-61. doi: 10.12659/AJCR.889484. eCollection 2013.
Female, 70 FINAL DIAGNOSIS: SA block induced by pyridostigmine Symptoms: Asymptomatic Medication: Pyridostigmine Clinical Procedure: Pacemaker insertion Specialty: Electrophysiology.
Unusual clinical course.
Myasthenia gravis requires a long-term treatment with a parasympathomimetic agent, which may result in bradycardia and asystole. Pharmacologic treatment with a reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH) and Methylprednisolone is seen to improve the muscular symptoms but may reinforce potential bradyarrhythmias. This potential side effect can be treated with the levo isomer of atropine, Hyoscyamine, or Glycopyrollate in an intact conduction system.
A 70-year old Caucasian female patient with a family history of myasthenia gravis presented with mild weakness of the bilateral facial muscles, moderate dysarthria, dysphagia, diplopia predominantly on the right side and difficulty tracking ocular movements bilaterally. The treatment with pharmacological agents was initiated. Subsequently she developed asymptomatic bradycardia and SA-block. An improvement on Hyoscyamine failed to appear. A dual chamber pacemaker was placed.
In symptomatic or asymptomatic bradycardia with significant high grade SA-block in patients with myasthenia gravis the insertion of a permanent pacemaker can be the definitive solution.
女性，70岁 最终诊断：吡啶斯的明诱发的窦房阻滞 症状：无症状 用药：吡啶斯的明 临床操作：植入起搏器 专业：电生理学
不寻常的临床病程
重症肌无力需要使用拟副交感神经药物进行长期治疗，这可能导致心动过缓和心搏停止。使用肌苷单磷酸脱氢酶（IMPDH）可逆抑制剂和甲泼尼龙进行药物治疗可改善肌肉症状，但可能会加重潜在的缓慢性心律失常。在传导系统完整的情况下，这种潜在的副作用可用阿托品的左旋异构体、莨菪碱或格隆溴铵治疗。
一名有重症肌无力家族史的70岁白人女性患者，出现双侧面部肌肉轻度无力、中度构音障碍、吞咽困难、主要为右侧的复视以及双侧眼球运动追踪困难。开始使用药物治疗。随后她出现无症状性心动过缓和窦房阻滞。使用莨菪碱后未见改善。植入了双腔起搏器。
对于重症肌无力患者出现有症状或无症状的心动过缓且伴有严重高度窦房阻滞时，植入永久性起搏器可能是最终的解决办法。
