tailieunhanh - báo cáo khoa học: "Emotional stress as a trigger of myasthenic crisis and concomitant takotsubo cardiomyopathy: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Emotional stress as a trigger of myasthenic crisis and concomitant takotsubo cardiomyopathy: a case report | Beydoun et al. Journal of Medical Case Reports 2010 4 393 http content 4 1 393 jAg JOURNALOF medical ÌỤr case REPORTS CASE REPORT Open Access Emotional stress as a trigger of myasthenic crisis and concomitant takotsubo cardiomyopathy a case report Said R Beydoun1 JingTian Wang1 Reed Loring Levine2 Ali Farvid3 Abstract Introduction Myasthenia gravis is a neuromuscular junction post-synaptic autoimmune disorder. Myasthenic crisis is characterized by respiratory failure requiring mechanical ventilation. Takotsubo cardiomyopathy is a rare clinical syndrome defined as a profound but reversible left ventricular dysfunction in the absence of coronary artery disease. Case presentation We report a unique case of a 60-year-old Hispanic woman with myasthenia gravis who developed takotsubo cardiomyopathy and concomitant myasthenic crisis that appear to have been triggered by a stressful life event. On admission she presented with severe mid-sternal chest pain and shortness of breath shortly after a personally significant stressful life event. A pertinent neurological examination showed bilateral facial weakness and right ptosis. The left ventriculogram showed apical ballooning with hyperdynamic proximal segments with sparing of the apex. Her troponin I level was elevated while cardiac catheterization revealed no significant coronary artery disease. The findings were consistent with takotsubo cardiomyopathy. Shortly after cardiac catheterization she developed bilateral ophthalmoparesis and significant bulbar and respiratory muscle weakness. Forced vital capacity values were persistently less than 1 L. The patient developed respiratory failure and required endotracheal intubation. After plasmapheresis and corticosteroid treatment her clinical course improved with successful extubation. A normal left ventricle chamber size and a normal ejection fraction were noted by an echocardiogram repeated 10 months later. Conclusion This is the first reported case