Battineni Anusha, Mullaguri Naresh, Thanki Shail, Chockalingam Anand, Govindarajan Raghav
Department of Neurology, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA.
Department of Cardiology, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA.
Case Rep Crit Care. 2017;2017:5702075. doi: 10.1155/2017/5702075. Epub 2017 Oct 19.
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.
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.
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.
重症肌无力危象患者可能因情绪或身体应激以及循环儿茶酚胺水平升高而发生应激性心肌病（Takotsubo心肌病）。我们报告了一名在重症肌无力危象期间发生复发性Takotsubo心肌病的患者。需要评估已知会诱发应激性心肌病的共存自身免疫性疾病，如格雷夫斯病。
一名69岁女性，血清学阳性重症肌无力（MG）、格雷夫斯病和冠状动脉疾病，每月接受静脉注射免疫球蛋白（IVIG）、泼尼松、吡啶斯的明和甲巯咪唑治疗，出现呼吸急促和胸痛。心电图（ECG）显示前外侧导联ST段抬高伴肌钙蛋白血症。冠状动脉造影显示无闭塞性冠状动脉疾病，左心室造影显示壁运动减弱，左心室心尖和中部运动减弱，提示Takotsubo应激性心肌病。她的症状归因于重症肌无力危象。经过五个周期的血浆置换（PLEX）后，她的症状、心电图和超声心动图检查结果均得到缓解。一年后，她在重症肌无力危象期间又出现了一次类似发作，PLEX治疗10天后症状随后缓解。
Takotsubo心肌病可能是重症肌无力危象的表现之一，无论是否合并格雷夫斯病。在给予IVIG和PLEX等抢救治疗时，这些患者可能受益于细致的液体状态和心脏监测。
