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Published 16 February 2009
Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.06.2008.0182]
Copyright © 2009 by the BMJ Publishing Group Ltd.

Unusual association of diseases/symptoms

Tako-tsubo cardiomyopathy in a patient with myasthenia gravis crisis: a rare clinical association

Sasidharan Bijulal1, Sivadasanpillai Harikrishnan1, Narayanan Namboodiri1, Valaparambil K Ajitkumar1, Deepak Gupta2, P S Mathuranath2

1 Sree Chitra Tirunal Institute for Medical Sciences and Technology, Cardiology, Trivandrum, 691303, India
2 Sree Chitra Tirunal Institute for Medical Sciences and Technology, Neurology, Trivandrum, 691303, India

Correspondence to:
bijulalsasidharan{at}gmail.com

SUMMARY

Tako-tsubo cardiomyopathy (TTC) is increasingly being recognised as transient left ventricular dysfunction following various hyperadrenergic states such as emotional or physical stressors. The association of this rare clinical entity with myasthenia gravis (MG) has been reported only twice in the literature, both following plasmapheresis for MG crisis. Here we describe a unique case of TTC in a 40-year-old woman with MG admitted with MG crisis managed conservatively. This case suggests that plasmapheresis is unlikely to have a causative role in the development of TTC in these patients. Patients with MG crisis may be at potential risk of developing TTC and careful clinical and electrocardiographic monitoring is necessary while treating them. The possible role of stress as the common precipitating factor in both conditions is also discussed.


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