Key result
Plasmapheresis for a myasthenic crisis in a 72-year-old man was complicated by the development of fatal Takotsubo cardiomyopathy and cardiogenic shock.
Why the study?
Reports of myasthenic crises complicated by Takotsubo cardiomyopathy are scarce.
Can plasmapheresis induce Takotsubo cardiomyopathy in patients with myasthenia crisis?
Case Report (n=1)
No
Can plasmapheresis induce Takotsubo cardiomyopathy in patients with myasthenia crisis?
This case highlights the rare but severe potential for plasma exchange therapy to induce Takotsubo cardiomyopathy and cardiogenic shock in patients with myasthenia crisis.
MC complicated by TC signals higher mortality; hypothesis-generating for cardiac monitoring protocols in myasthenic crisis.
A literature review shows scarce reports of myasthenic crises (MC) complicated by Takotsubo cardiomyopathy (TC). This patient cohort (0.11%) has higher all-cause mortality and prolonged in-hospital course. We present a rare case of a 72-year-old man who developed cardiogenic shock post-plasmapheresis for myasthenia crisis. He became hemodynamically unstable and developed acute respiratory failure requiring intubation 30 minutes after completion of plasma exchange. Serum troponin peaked at 3.19 ng/mL while an emergent 12-lead electrocardiogram (EKG) showed new-onset diffuse ST-segment elevation. Hypokinesis of the entire apex, anterior septum, mid-and apical inferior septum, and mid-and apical inferior wall consistent with Takotsubo cardiomyopathy was seen on bedside echocardiogram. The patient received a continuous infusion of norepinephrine and vasopressin. The hospital course was complicated by multiorgan failure and eventual demise. This case highlights MC and the potential of plasma exchange therapy to induce TC.
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Jahangir et al. (2022) conducted a case report in Myasthenia Crisis and Takotsubo Cardiomyopathy (n=1). Plasmapheresis was evaluated on Clinical outcome. Plasmapheresis for a myasthenic crisis in a 72-year-old man was complicated by the development of fatal Takotsubo cardiomyopathy and cardiogenic shock.
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