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

Taylor M Douglas,Jacob Schwartz,Perry Wengrofsky,Syed Haseeb,Pramod Theetha Kariyanna,Eric Kupferstein,Louis Salciccioli,Samy I Mcfarlane

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.

Highlights

Takotsubo Cardiomyopathy (TC), referred to as “broken-heart” syndrome and “stress cardiomyopathy”, is a syndrome characterized by transient and reversible regional myocardial dysfunction with various patterns of regional hyperkinesis and hypokinesis in the absence of underlying obstructive coronary artery disease (CAD), most classically with left ventricular (LV) apical hypokinesis and basal hyperkinesis resulting in apical ballooning [1,2]
TC associated with Myasthenia Gravis (MG) most prominently appears during myasthenic crisis (MC), an acute deterioration of MG typically brought on by a physical or emotional stressor that usually involves respiratory muscles resulting in respiratory failure and the need for mechanical ventilation [6]
TC in the setting of MC has been attributed to adverse catecholaminergic associated with the severe stress precipitated by MC, and to the temporal relationship that has been extensively documented between physical or emotional stress, the onset of TC and the reversibility of TC with resolution of antecedent stressor

Summary

Introduction

Takotsubo Cardiomyopathy (TC), referred to as “broken-heart” syndrome and “stress cardiomyopathy”, is a syndrome characterized by transient and reversible regional myocardial dysfunction with various patterns of regional hyperkinesis and hypokinesis in the absence of underlying obstructive coronary artery disease (CAD), most classically with left ventricular (LV) apical hypokinesis and basal hyperkinesis resulting in apical ballooning [1,2]. TC has been shown to have an overwhelming female predominance and average age of onset of 66, with strong temporal associations to emotional and physical stress, with postulated mechanisms centered around catecholamine-induced myocardial injury and catecholamine-mediated vascular spasm and dysfunction causing myocardial stunning [3,4]. TC associated with MG most prominently appears during myasthenic crisis (MC), an acute deterioration of MG typically brought on by a physical or emotional stressor that usually involves respiratory muscles resulting in respiratory failure and the need for mechanical ventilation [6]. Previous reports of MC triggered TC demonstrate a female predominance with variable antecedent history of thymectomy [6]. We present the first reported case of TC in MC in a male patient after thymectomy

Case Report

Findings

Discussion