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

Abstract

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.

Figure 1. End systolic frame of left ventricular angiogram in right anterior oblique projection showing the peculiar shape reminiscent of a “tako-tsubo”, an octopus trap, used in Japan.

Figure 2. End diastolic frame of left ventricular angiogram in right anterior oblique projection showing dilated left ventricle.

Figure 3. Left coronary angiography in 30° right anterior oblique projection demonstrating normal left coronary artery.