Abstract

Background

Myasthenic crisis is characterized by severe weakness in bulbar and respiratory muscles leading to respiratory failure and can be a natural result of myasthenia gravis or precipitate due to infections, surgeries, and pregnancy. It has been shown that stressful emotional events can lead to stress, or takotsubo cardiomyopathy. Takotsubo cardiomyopathy is characterized by transient reversible left ventricular dysfunction in the absence of obstructive artery disease with hypo- or akinesis of the apex with hypercontractility of the base.

Methods

Case report and review of literature.

Results

We report a 77-year old man with myasthenia gravis that was admitted to the neurological intensive care unit due to a myasthenic crisis. During the course of his treatment with plasma exchange, he developed hypotension with a reduced cardiac ejection fraction found on transthoracic electrocardiography. Repeat echocardiography 2 and 8 days later showed a normal ejection fraction and resolved cardiac function.

Conclusion

While takotsubo cardiomyopathy rarely presents concurrently with a myasthenic crisis, its consideration is warranted in the face of cardiovascular decompensation. Given that several cardiac complications are known to be associated with myasthenic crisis, cardiac monitoring is advised. Nine reports describe takotsubo cardiomyopathy occurring concurrently with a myasthenic crisis; however, only one report demonstrates this association in the absence of concomitant comorbidities or significant emotional distress.

中文翻译：

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肌无力危象中的 Takotsubo 心肌病

摘要

背景

肌无力危象的特征是延髓和呼吸肌严重无力导致呼吸衰竭，可能是重症肌无力的自然结果，也可能是感染、手术和妊娠引起的沉淀。已经表明，压力性情绪事件会导致压力或 takotsubo 心肌病。Takotsubo 心肌病的特征是短暂可逆的左心室功能障碍，在没有阻塞性动脉疾病的情况下，伴有心尖部收缩功能减退或运动不畅，基部收缩过度。

方法

病例报告及文献复习。

结果

我们报告了一名患有重症肌无力的 77 岁男性，他因肌无力危象被送入神经重症监护室。在进行血浆置换治疗期间，他出现了低血压，经胸心电图显示心脏射血分数降低。2 天和 8 天后重复超声心动图显示射血分数正常，心功能恢复。

结论

虽然 takotsubo 心肌病很少同时出现肌无力危象，但在心血管失代偿的情况下需要考虑它。鉴于已知几种心脏并发症与肌无力危象有关，建议进行心脏监测。九份报告描述了与肌无力危象同时发生的 takotsubo 心肌病；然而，只有一份报告在没有伴随合并症或严重情绪困扰的情况下证明了这种关联。