Pulmonary Edema in Myasthenic Crisis

We report a previously asymptomatic 50-year-old lady who came with myasthenic crisis as initial presentation of myasthenia gravis. She developed pulmonary edema following intravenous immunoglobulin administration and had ischemic changes in ECG and left ventricular dysfunction on echocardiography. She improved with diuretics, dobutamine, and fluid restriction alone. This is the first report in English-language medical literature describing the association between myasthenic crisis and likely takotsubo cardiomyopathy-related pulmonary edema following intravenous immunoglobulin administration.

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Takotsubo Cardiomyopathy After Severe Burn Injury: A Poorly Recognized Cause of Acute Left Ventricular Dysfunction

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e318165b311 ◽

2010 ◽

Vol 68 (3) ◽

pp. E77-E79 ◽

Cited By ~ 3

Author(s):

Shoji Yokobori ◽

Masato Miyauchi ◽

Shigeyoshi Eura ◽

Takeshi Uchikawa ◽

Tomohiko Masuno ◽

...

Keyword(s):

Left Ventricular Dysfunction ◽

Takotsubo Cardiomyopathy ◽

Ventricular Dysfunction ◽

Burn Injury ◽

Left Ventricular ◽

Severe Burn ◽

Severe Burn Injury

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Myasthenia gravis in children: analysis of 18 patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2001000500005 ◽

2001 ◽

Vol 59 (3B) ◽

pp. 681-685 ◽

Cited By ~ 13

Author(s):

Maria da Penha A. Morita ◽

Alberto A. Gabbai ◽

Acary S.B. Oliveira ◽

Audrey S. Penn

Keyword(s):

Myasthenia Gravis ◽

Intravenous Immunoglobulin ◽

Acetylcholine Receptor ◽

Nerve Stimulation ◽

Chest Ct ◽

Clinical Severity ◽

Myasthenic Crisis ◽

Repetitive Nerve Stimulation ◽

Follicular Hyperplasia ◽

Receptor Antibodies

Myasthenia gravis (MG) in childhood is rare comprising 10 to 20 % of all myasthenic patients. We studied 18 patients with MG whose first symptoms started from 1 to 12 years of age, followed at the Department of Neurology of the UNIFESP-EPM, from January 1983 to August 1997. There were 10 girls and 8 boys (1.2:1). Eleven patients (61%) presented moderate or severe generalized disease and 4 (22%) had at least one myasthenic crisis. EMG with supramaximal repetitive nerve stimulation was diagnostic in 8 (47%) out of 17 patients, and chest CT was normal in 14 patients. Seropositivity to acetylcholine receptor antibodies was found in 81.6% (9 out of 11 tested) and the levels had no relation to clinical severity. Nine out of 16 patients (56%) worsened with pyridostigmine alone and were treated with prednisone. Four out of those nine continued worsening despite steroids and were subjected to thymectomy (all showed thymic lymphoid follicular hyperplasia). Three patients (75%) improved markedly after thymectomy and one (25%) worsened, eventually getting better with intravenous immunoglobulin and oral azathioprine. MG treatment, using all resources available, has to be individualized for each child.

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Takotsubo Cardiomyopathy in a Squash Player

Cardiology Research and Practice ◽

10.4061/2009/351621 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Mathieu Berry ◽

Jerome Roncalli ◽

Olivier Lairez ◽

Meyer Elbaz ◽

Didier Carrié ◽

...

Keyword(s):

Takotsubo Cardiomyopathy ◽

Wall Motion ◽

Ventricular Dysfunction ◽

Apical Ballooning ◽

Regional Wall Motion ◽

Left Ventricular ◽

The Body ◽

Coronary Syndrome ◽

Regional Wall Motion Abnormalities ◽

Wall Motion Abnormalities

Takotsubo cardiomyopathy is usually described following acute emotional stress. We report here the case of a 48-year-old woman admitted for acute coronary syndrome after an intensive squash match. Diagnosis of Takotsubo cardiomyopathy due to acute physical stress was suspected in presence of normal coronary arteries and transitory left ventricular dysfunction with typical apical ballooning. Cardiac magnetic resonance imaging confirmed regional wall-motion abnormalities and was helpful in excluding myocardial infarction diagnosis. During squash the body is subject to sudden and vigorous demands inducing a prolonged and severe workload on the myocardium.

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Late-Term Complications of COVID-19: Retropharyngeal Infection and Myocarditis in a 26-Year-Old Patient

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002759 ◽

2021 ◽

Author(s):

Mohammad Yousef Mohammad Yousef ◽

Basel Abdelazeem ◽

Atefeh Kalantary ◽

Rebecca Pratiti

Keyword(s):

Ventricular Dysfunction ◽

Medical Literature ◽

Acute Myocarditis ◽

Late Complication ◽

Viral Myocarditis ◽

Left Ventricular ◽

Severe Left Ventricular Dysfunction ◽

Clinical Challenge ◽

History Of ◽

Tomography Scan

Deep neck space infection and viral myocarditis related to coronavirus disease 2019 (COVID-19) have both been described in the medical literature. However, there are only three reported cases of retropharyngeal infection as a presenting pathology in the setting of COVID-19. A 26-year-old woman presented to the emergency room with fever and neck swelling and pain 1 month after COVID-19 infection. A computed tomography scan of the neck demonstrated tonsillitis with retropharyngeal infection. She was also found to have heart failure with an ejection fraction (EF) of <20% due to acute myocarditis. Her infection resolved and the EF improved to 40% prior to discharge. Our case is the first to describe retropharyngeal infection as a late complication in an adult with a history of COVID-19 several weeks previously. It also presented a clinical challenge in terms of tailoring goal-directed medical therapy to manage severe left ventricular dysfunction caused by myocarditis.

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THIS TOO SHALL PASS (UNTIL IT DOESN'T): A RARE CASE OF TAKOTSUBO CARDIOMYOPATHY WITH PERSISTENT LEFT VENTRICULAR DYSFUNCTION

CHEST Journal ◽

10.1016/j.chest.2019.08.378 ◽

2019 ◽

Vol 156 (4) ◽

pp. A335

Author(s):

Sharmila Sarkar ◽

Christina Jee Ah Rhee ◽

Rakesh Gupta

Keyword(s):

Left Ventricular Dysfunction ◽

Takotsubo Cardiomyopathy ◽

Rare Case ◽

Ventricular Dysfunction ◽

Left Ventricular

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Reversible Left Ventricular Dysfunction "Takotsubo" Cardiomyopathy Associated With Hyperthyroidism

Japanese Heart Journal ◽

10.1536/jhj.45.889 ◽

2004 ◽

Vol 45 (5) ◽

pp. 889-894 ◽

Cited By ~ 20

Author(s):

Shinsuke Miyazaki ◽

Tetsuo Kamiishi ◽

Noriyo Hosokawa ◽

Masatoshi Komura ◽

Hideo Konagai ◽

...

Keyword(s):

Left Ventricular Dysfunction ◽

Takotsubo Cardiomyopathy ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Reversible Left Ventricular Dysfunction

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Can a pneumothorax break your heart?

Medical Journal of Indonesia ◽

10.13181/mji.v24i1.1179 ◽

2015 ◽

Vol 24 (1) ◽

pp. 55-8 ◽

Cited By ~ 1

Author(s):

Stylianos Mavridis ◽

Hans-Georg Gnauk ◽

Silvio Horn ◽

Peter Adeberg ◽

Martina Schumacher ◽

...

Keyword(s):

Takotsubo Cardiomyopathy ◽

Ventricular Dysfunction ◽

Troponin I ◽

Apical Ballooning ◽

Left Ventricular ◽

Air Leakage ◽

St Segment Elevation ◽

St Segment ◽

Electrocardiographic Findings ◽

Significant Coronary Stenosis

Takotsubo cardiomyopathy or apical ballooning is a condition characterized by transitory left ventricular dysfunction, affecting commonly postmenopausal females after foregoing acute emotional or physical stress. We report a case of a 63 year old female presenting with severe dyspnea and right-sided secondary spontaneous pneumothorax, initially treated with tube thoracostomy. Despite the fact that pneumothorax resolved, shortness of breath persisted and due to ST-segment elevation and increased Troponin I levels, she was admitted to cardiac catheterization. A significant coronary stenosis was ruled out and the diagnosis of a Takotsubo cardiomyopathy was established. Electrocardiographic findings were normalized within three days and attributable to prolonged air leakage. A thoracoscopic apex resection followed by a partial parietal pleurectomy was performed. Although Takotsubo cardiomyopathy is a rare syndrome, it should always be considered as a potential cardiac complication of a pneumothorax.

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Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286419864497 ◽

2019 ◽

Vol 12 ◽

pp. 175628641986449 ◽

Cited By ~ 3

Author(s):

Josep Gamez ◽

María Salvadó ◽

Francesc Carmona ◽

Miriam de Nadal ◽

Laura Romero ◽

...

Keyword(s):

Placebo Group ◽

Myasthenia Gravis ◽

General Anaesthesia ◽

Intravenous Immunoglobulin ◽

Univariate Analysis ◽

Myasthenic Crisis ◽

Double Blind ◽

Single Centre Study ◽

Life Threatening ◽

The Mean

Background: Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. Methods: A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. Results: A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m2, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. Conclusions: Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia.

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