1
|
Khadka J, Bhattarai P, Adhikari A, Acharya R, Rayamajhi P. Myasthenic crisis-induced Takotsubo cardiomyopathy: a case report. Ann Med Surg (Lond) 2024; 86:1704-1707. [PMID: 38463080 PMCID: PMC10923365 DOI: 10.1097/ms9.0000000000001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/05/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Myasthenic crisis (MC) is characterized by severe weakness in the bulbar and respiratory muscles. Takotsubo cardiomyopathy (TC) is a rare clinical entity mainly associated with postmenopausal women. We report a case of both these conditions in a premenopausal woman. Case presentation A 31-year-old woman with hypothyroidism presented with dyspnea. Bedside echocardiography in the ICU revealed an apical ballooning with an ejection fraction of 25%, and she was treated with losartan, furosemide, and spironolactone. She was intubated after 2 days as she developed respiratory distress and type II respiratory failure. Upon investigation, the patient tested positive for anti-acetylcholine receptor antibody. Treatment with five doses of IVIG (intravenous immunoglobulin) was given, and she made a remarkable recovery. Repeat echocardiography revealed her ejection fraction is normal and cardiac function is resolved. Clinical discussion The association between TC and MC is unusual and not commonly observed. MC can be a natural progression of myasthenia gravis or due to stressors, such as infection, medicine, pregnancy, and surgery. Stressful events can lead to TC. This leads to the possibility of TC, along with other cardiac complications, in patients with MC. Conclusion Patients with MC may be at potential risk of developing TC, thus careful cardiac monitoring is necessary while treating them for a better prognosis.
Collapse
Affiliation(s)
| | | | | | - Rajat Acharya
- Department of Internal Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | | |
Collapse
|
2
|
Gayfield S, Busken J, Mansur S. A Case Report and 31-Case Study: Does Takotsubo Cardiomyopathy in Myasthenia Gravis Patients Have a High Mortality Rate? Cureus 2022; 14:e28625. [PMID: 36196306 PMCID: PMC9525054 DOI: 10.7759/cureus.28625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Myasthenia gravis is an autoimmune disorder in which antibodies are formed against post-synaptic nicotinic acetylcholine receptors that lead to impeded muscle contraction and commonly affects the oculomotor muscles. Takotsubo cardiomyopathy (TTC) is a dilated cardiomyopathy that can mimic a myocardial infarction and causes reversible systolic dysfunction. This is a case of a 66-year-old Caucasian male with a known history of ocular myasthenia gravis that presented to the emergency room with worsening dyspnea secondary to a myasthenic crisis. One day, following admission, his shortness of breath failed to improve and was found to meet the diagnostic criteria for takotsubo cardiomyopathy. A brief review of 31 previous cases summarizes the current case reports, patterns, and mortality associated with the myasthenic crisis associated with TTC.
Collapse
|
3
|
Kuo Y, Ottens TH, van der Bilt I, Keunen RWM, Akin S. Myasthenic crisis-induced Takotsubo cardiomyopathy in an elderly man: A case report of an underestimated but deadly combination. World J Cardiol 2021; 13:21-27. [PMID: 33552400 PMCID: PMC7821008 DOI: 10.4330/wjc.v13.i1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with myasthenia gravis (MG) are at a higher risk of developing Takotsubo cardiomyopathy (TTC), particularly during a myasthenic crisis. Myasthenic crisis-associated TTC occurs predominantly in women. In this case report, we present a man with metastasized prostate carcinoma who developed TTC after new-onset MG.
CASE SUMMARY An 81-year-old man with non-insulin dependent diabetes mellitus and metastasized prostate carcinoma presented with dyspnea. During primary assessment examination at the emergency department, there was evident blepharoptosis of his right eye. His electrocardiograms were suggestive of an acute anterior wall myocardial infarction, for which he underwent emergency coronary angiography. No obstructive coronary artery disease was found. During the coronary angiography, the patient developed respiratory failure and was admitted to the Intensive Care Unit for non-invasive respiratory support. The following day, diagnostic neostigmine test revealed a myasthenic crisis. Bedside echocardiography revealed left ventricular apical ballooning with a typical appearance of TTC. Despite the potentially reversible character of both MG and TTC, the patient and family requested an end of support in the Intensive Care Unit due to age and chronic malignancy with reduced quality of life in recent months after non-chemo-responding prostate carcinoma. The patient died soon after treatment withdrawal.
CONCLUSION Elderly men should be carefully evaluated for TTC when new-onset MG is diagnosed.
Collapse
Affiliation(s)
- Yvonne Kuo
- Intensive Care Unit, Hagaziekenhuis, The Hague 2545, Netherlands
| | - Thomas H Ottens
- Intensive Care Unit, Hagaziekenhuis, The Hague 2545, Netherlands
| | - Ivo van der Bilt
- Department of Cardiology, Hagaziekenhuis, The Hague 2545, Netherlands
| | - Ruud WM Keunen
- Department of Neurology, Haga Teaching Hospital, The Hague 2545, Netherlands
| | - Sakir Akin
- Intensive Care Unit, Hagaziekenhuis, The Hague 2545, Netherlands
| |
Collapse
|
4
|
Finsterer J. Comment on: Takotsubo cardiomyopathy, or 'broken-heart syndrome', with concomitant myasthenic crisis. Singapore Med J 2019; 60:551. [PMID: 31663095 DOI: 10.11622/smedj.2019133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Josef Finsterer
- Neurological Department, Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| |
Collapse
|
5
|
Desai R, Abbas SA, Fong HK, Lodhi MU, Doshi R, Savani S, Gangani K, Sachdeva R, Kumar G. Burden and impact of takotsubo syndrome in myasthenic crisis: A national inpatient perspective on the under-recognized but potentially fatal association. Int J Cardiol 2019; 299:63-66. [PMID: 31611084 DOI: 10.1016/j.ijcard.2019.09.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with myasthenia gravis (MG) remain at a higher risk of developing takotsubo syndrome (TS), particularly during a myasthenic crisis (MC) event. The prevalence of MC-associated TS and its impact on subsequent in-hospital outcomes have not been explored previously. METHODS We queried the National Inpatient Sample (NIS) databases (2007-2014) using weighted data and ICD-9 CM codes to evaluate the prevalence of MC-associated TS, demographics, comorbidities and inpatient outcomes of TS secondary to MC vs. other triggers. RESULTS The nationwide prevalence of MC-associated TS was 0.3% (175/56,472). Of all 156,506 TS encounters, MC was present in 0.11% (n = 175) of cases. The groups were comparable in terms of demographics (median age 68-73 years, Caucasian >70%, females >80%). In comparison to non-MC TS, MC-associated TS demonstrated a higher frequency of coexisting diabetes and a lower frequency of smoking. The MC-TS cohort experienced significantly higher rates of all-cause mortality [8.6% vs. 4.7%, p = 0.014, unadjusted (OR1.91, p = 0.017) and adjusted (OR1.82, p = 0.038)] and complications including respiratory failure, the need of intubation/mechanical ventilation, and arrhythmia. The MC-TS cohort had fewer routine discharges and frequent transfers. The median stay was 6 days longer (10 vs. 4 days) and median hospital charges per admission were nearly $100,000 higher ($133,999 vs. $38,367) with MC-associated TS. CONCLUSIONS This population-based analysis revealed a 15 times greater prevalence of secondary TS following MC as compared to the general inpatient population, a nearly 2 times higher odds of all-cause mortality, and significantly higher resource utilization in MC-associated TS as compared to TS triggered by other etiologies.
Collapse
Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA.
| | | | - Hee Kong Fong
- Division of Cardiovascular Medicine, UC Davis Health System, Sacramento, CA, USA
| | - Muhammad Uzair Lodhi
- Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, ID, USA
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Sejal Savani
- Public Health, New York University, New York, NY, USA
| | - Kishorbhai Gangani
- Department of Internal Medicine, Texas Health Arlington Memorial Hospital, Arlington, TX, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA; Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA; Division of Cardiology, Medical College of Georgia, Augusta, GA, USA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|