Khan Mohammad Saud, Tiwari Abhinav, Khan Zubair, Sharma Himani, Taleb Mohammad, Hammersley Jeffrey
Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.
Department of Internal Medicine and Department of Pulmonary/Critical Care, University of Toledo Medical Center, Toledo, OH, USA.
Case Rep Cardiol. 2017;2017:6956298. doi: 10.1155/2017/6956298. Epub 2017 May 14.
Reversible acetylcholinesterase inhibitors are used as first-line treatment for myasthenia gravis. They improve symptoms by increasing concentration of acetylcholine at the neuromuscular junction and stimulating nicotinic receptors. Serious bradyarrhythmias can occur from muscarinic stimulation in heart, which in rare cases may progress to asystole. These patients can initially be managed with hyoscyamine, a muscarinic antagonist. Persistence of bradyarrhythmias even after hyoscyamine treatment may warrant pacemaker placement. We present a case of 65-year-old female patient who presented with diplopia, dysphagia, and muscle weakness who was diagnosed with myasthenia gravis. She developed significant sinoatrial node block with prolonged asystole after starting treatment with pyridostigmine which was successfully treated with hyoscyamine, thus avoiding pacemaker placement.
可逆性乙酰胆碱酯酶抑制剂被用作重症肌无力的一线治疗药物。它们通过增加神经肌肉接头处乙酰胆碱的浓度并刺激烟碱样受体来改善症状。心脏的毒蕈碱样刺激可导致严重的缓慢性心律失常，在极少数情况下可能进展为心搏停止。这些患者最初可用毒蕈碱拮抗剂东莨菪碱进行治疗。即使在使用东莨菪碱治疗后仍持续存在缓慢性心律失常，可能需要植入起搏器。我们报告一例65岁女性患者，她出现复视、吞咽困难和肌肉无力，被诊断为重症肌无力。她在开始使用吡啶斯的明治疗后出现了显著的窦房结阻滞并伴有长时间的心搏停止，经东莨菪碱成功治疗，从而避免了起搏器植入。
