Letter to the EditorCoronary vasospasm secondary to hypercholinergic crisis: An iatrogenic cause of acute myocardial infarction in myasthenia gravis
Introduction
Lifelong anticholinesterase treatment is common in patients with myasthenia gravis in order to control symptoms and to potentially improve life expectancy.[1] While usually safe, anticholinesterases can occasionally precipitate hypercholinergic crises and adversely affect the heart. We originally report a case of acute myocardial infarction due to iatrogenic hypercholinergic coronary vasospasm in an elderly female with myasthenia gravis.
Section snippets
Case
A 75-year-old woman was admitted to the Coronary Care Unit for acute myocardial infarction with antero-lateral ST-elevation (Fig. 1A). History was significant for past cigarette smoking. Myasthenia gravis was currently treated with a high-dose anticholinesterase agent (pyridostigmine) and corticosteroids, and oral anticoagulant therapy for recent pulmonary thromboembolism.
Because of the elevated INR before admission and the long pre-thrombolytic time (10 h), the patient was not treated with
Discussion
Patients with myasthenia gravis are treated lifelong with anticholinesterase agents, such as pyridostigmine, which are usually associated with few cardiovascular adverse effects at typical therapeutic doses [1], [3]. Indeed, medical emergencies associated with this disease (i.e. myasthenic crisis) are usually due to subtherapeutic anticholinesterase effect leading to muscle weakness and ultimately to respiratory failure [3]. Nonetheless, clinicians should bear in mind the risk for adverse
Acknowledgements
The authors have no competing interest or funding source to declare.
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