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American Journal of Medical Case Reports. 2018, 6(9), 184-188
DOI: 10.12691/AJMCR-6-9-4
Review Article

Takotsubo Cardiomyopathy Mimicking Myocardial Infarction in a Man with Myasthenic Crisis: A Case Report and Literature Review

Taylor M. Douglas1, Perry Wengrofsky1, Syed Haseeb1, Eric Kupferstein2, Pramod Theetha Kariyanna2, Jacob Schwartz1, Louis Salciccioli2 and Samy I. McFarlane1,

1Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y, U.S.A-11203

2Division of Cardiovascular Disease, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y, U.S.A-11203

Pub. Date: October 11, 2018
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Cite this paper

Taylor M. Douglas, Perry Wengrofsky, Syed Haseeb, Eric Kupferstein, Pramod Theetha Kariyanna, Jacob Schwartz, Louis Salciccioli and Samy I. McFarlane. Takotsubo Cardiomyopathy Mimicking Myocardial Infarction in a Man with Myasthenic Crisis: A Case Report and Literature Review. American Journal of Medical Case Reports. 2018; 6(9):184-188. doi: 10.12691/AJMCR-6-9-4

Abstract

Takotsubo Cardiomyopathy is a syndrome characterized by transient and reversible regional myocardial dysfunction in the absence of obstructive coronary artery disease classically resulting in ventricular apical ballooning. It has a strong female predominance with onset generally in seventh decade of life, with hypothesized pathophysiology related to excess of catecholaminergic stimulation, particularly during episodes of physical or emotional stress. Takotsubo cardiomyopathy has been previously reported during myasthenic crisis, the acute deterioration of myasthenia gravis typically involving respiratory failure that is also associated with physical or emotional stress. We present the case of an atypically young male patient with classical takotsubo cardiomyopathy in the setting of myasthenic crisis after thymectomy initially concerning for ST segment elevation myocardial infarction, and a review of the literature of takotsubo cardiomyopathy in myasthenic crisis.

Keywords

myasthenic crisis, takotsubo cardiomyopathy, male, thymectomy

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Annals of internal medicine. 2004 Dec 7; 141(11): 858-65.
 
[2]  Satoh H. Takotsubo-type cardiomyopathy due to multivessel spasm. Clinical aspect of myocardial injury: from ischemia to heart failure. 1990.
 
[3]  Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. New England Journal of Medicine. 2015 Sep 3; 373(10): 929-38.
 
[4]  Nef HM, Möllmann H, Kostin S, Troidl C, Voss S, Weber M, Dill T, Rolf A, Brandt R, Hamm CW, Elsässer A. Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. European heart journal. 2007 Mar 29; 28(20): 2456-64.
 
[5]  Shivamurthy P, Parker M. Cardiac manifestations of myasthenia gravis: A systematic review. IJC Metabolic and Endocrine. 2014; 5: 3-6.
 
[6]  Finsterer J, Stollberger C. Stress from myasthenic crisis triggers Takotsubo (broken heart) syndrome. International Journal of Cardiology. 2016; 203: 616-617.
 
[7]  Ghadri J, Wittstein IS, Prasad A, et al. International expert consensus document on Takotsubo Syndrome (Part I): Clinical characteristics, diagnostic criteria, and pathophysiology. European Heart Journal. 2018; 39: 2032-2046.
 
[8]  Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and outcomes of takotsubo (stress) cardiomyopathy. New England Journal of Medicine. 2015; 373: 929-938.
 
[9]  Lyon AR, Rees PS, Prasad S, et al. Stress (Takotsubo) cardiomyopathy - a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Clin Pract Cardiovasc Med. 2008; 5: 22-29.
 
[10]  Kawano H, Okada R, Yano K. Histological study on the distribution of autonomic nerves in the human heart. Heart Vessels. 2003; 18: 32-39.
 
[11]  Gopalakrishnan P, Zaidi R, Sardar MR. Takotsubo cardiomyopathy: Pathophysiology and role of cardiac biomarkers in differential diagnosis. World Journal of Cardiology. 2017; 9(9): 723-730.
 
[12]  Heubach JF, Ravens U, Kaumann AJ. Epinephrine activates both Gs and Gi pathways, but norepinephrine activates only the Gs pathway through human beta2-adrenoceptors overexpressed in mouse heart. Mol Pharmacol. 2004; 65: 1313-1322.
 
[13]  Paur H, Wright PT, Sikkel MS, et al. High levels of circulating epinephrine trigger apical cardiodepression in a ß2-adrenoceptor/Gi-dependent manner: A new model of Takotsubo cardiomyopathy. Circulation. 2012; 126(6): 697-706.
 
[14]  Peric S, Rakocevic-Stojanovic V, Nisic T, et al. Cardiac autonomic control in patients with myasthenia gravis and thymoma. Journal of the Neurological Sciences. 2011; 307: 30-33.
 
[15]  Benjamin RN, Aaron S, Sivadasan A, et al. The spectrum of autonomic dysfunction in myasthenic crisis. Annals of Indian Academy of Neurology. 2018; 21(1): 42-48.
 
[16]  Verna E, Provasoli S, Ghiringhelli S, et al. Abnormal coronary vasoreactivity in transient left ventricular apical ballooning (tako-tsubo) syndrome. International Journal of Cardiology. 2017; 250: 4-10.
 
[17]  Galiuto L, De Caterina AR, Porfidia A, et al. Reversible coronary microvascular dysfunction: a common pathogenetic mechanism in Apical Ballooning or Tako-Tsubo Syndrome. European Heart Journal. 2010; 31: 1319-1327.
 
[18]  Arai M, Ukigai H, Miyata H. A case of transient left ventricular ballooning (“Takotsubo”-shaped cardiomyopathy) developed during plasmapheresis for treatment of myasthenic crisis. Rinsho shinkeigaku= Clinical neurology. 2004 Mar; 44(3): 207-10.
 
[19]  Sousa JM, Knobel M, Buchelle G, et al. Transient ventricular dysfunction (Takotsubo cardiomyopathy). Arquivos brasileiros de cardiologia. 2005 Apr; 84(4): 340-2.
 
[20]  Hirose K, Yamaguchi H, Oshima Y, et al. Severe respiratory failure and torsades de pointes induced by disopyramide in a patient with myasthenia gravis. Internal Medicine. 2008; 47(19): 1703-8.
 
[21]  Bijulal S, Harikrishnan S, Namboodiri N, e al. Unusual association of diseases/symptoms: Tako-tsubo cardiomyopathy in a patient with myasthenia gravis crisis: a rare clinical association. BMJ case reports. 2009; 2009.
 
[22]  Beydoun SR, Wang J, Levine RL, et al. Emotional stress as a trigger of myasthenic crisis and concomitant takotsubo cardiomyopathy: a case report. Journal of medical case reports. 2010 Dec; 4(1): 393.
 
[23]  Bansal V, Kansal MM, Rowin J. Broken heart syndrome in myasthenia gravis. Muscle & nerve. 2011 Dec; 44(6): 990-3.
 
[24]  Gautier P, Ravan R, Najjar M, et al. Tako-Tsubo syndrome during normal human immunoglobolin perfusion. InAnnales de Cardiologie et d'Angéiologie 2011 Nov (Vol. 60, No. 5, pp. 290-295).
 
[25]  Wong CP, Chia PL. Recurrent takotsubo cardiomyopathy precipitated by myasthenic crisis. International journal of cardiology. 2012 Feb 23; 155(1): e11-2.
 
[26]  Nishinarita R, Kawamura Y, Yasuda T, et al. A case of takotsubo cardiomyopathy leading to the diagnosis of myasthenia gravis. Journal of Cardiology Cases. 2012 Nov 1; 6(5): e141-4.
 
[27]  Mayor-Gomez S, Lacruz F, et al. Myasthenic crisis and Takotsubo syndrome: a non-chance relationship. Revista de neurologia. 2012 Dec; 55(12): 725-8.
 
[28]  Valbusa A, Ingrassia S, Rosa GM, et al. Takotsubo cardiomyopathy and torsade de pointes in myasthenic crisis: be aware of QT prolongation. The American journal of emergency medicine. 2013 Dec 1; 31(12): 1717-8.
 
[29]  Anand US, Viswanathan S, Arulneyam J. Pulmonary edema in myasthenic crisis. Case reports in critical care. 2013; 2013.
 
[30]  Thanaviratananich S, Katirji B, Alshekhlee A. Broken heart syndrome during myasthenic crisis. Journal of clinical neuromuscular disease. 2014 Mar 1; 15(3): 90-5.
 
[31]  John A, Singh S, Singh A, et al. Reverse Takotsubo Cardiomyopathy from Myasthenic Crisis: A Case Report. Journal of Cardiovascular Diseases & Diagnosis. 2014 Sep 4.
 
[32]  Harries IB, Levoir H, Bucciarelli-Ducci C, et al. Case Report: Takotsubo cardiomyopathy in myasthaenia gravis crisis confirmed by cardiac MRI. BMJ case reports. 2015; 2015.
 
[33]  Escutia Cuevas HH, Domínguez López R, et al.. Síndrome de takotsubo asociado a crisis miasténica. Presentación de un caso. Revista mexicana de cardiología. 2016 Oct 15; 27(3): 123-9.
 
[34]  Battineni A, Mullaguri N, Thanki S, et al. A Case Report of Recurrent Takotsubo Cardiomyopathy in a Patient during Myasthenia Crisis. Case reports in critical care. 2017; 2017.
 
[35]  Jolly G, Haidry A, Koulova A, et al. Myasthenia gravis crisis associated stress (takotsubo) cardiomyopathy. Journal of the American College of Cardiology. 2018 Mar 10; 71 (11 Supplement): A2355.
 
[36]  Namgung J. Electrocardiographic Findings in Takotsubo Cardiomyopathy: ECG Evolution and Its Difference from the ECF of Acute Coronary Syndrome. Clinical Medicine Insights: Cardiology. 2014; 8: 29-34.