Takotsubo Cardiomyopathy Complicated with Left Ventricular Thrombus in Myasthenic Crisis: A Case Report

Abstract

BACKGROUND Myasthenia gravis can precipitate severe stress particularly during a myasthenic crisis episode. Takotsubo cardiomyopathy has been demonstrated in several conditions associated with emotional or physical stress. As a result, Takotsubo cardiomyopathy is not uncommon in patients with MG. The severe complications of Takotsubo cardiomyopathy include heart failure and left ventricular thrombus associated with thromboembolic risk. The concomitant myasthenic crisis and Takotsubo cardiomyopathy with apical left ventricular thrombus has never been reported. CASE REPORT A 67-year- old Thai female diagnosed with myasthenia gravis was admitted to the intensive care unit due to the myasthenic crisis. The 12-lead electrocardiogram showed marked QT interval prolongation and diffuse large T-wave inversion. Echocardiogram demonstrated basal hyperkinesia and apical akinesia with apical ballooning. Hyperechoic mass was noted in akinetic left ventricular apex. Takotsubo cardiomyopathy with apical left ventricular thrombus was diagnosed. Both conditions were successfully treated in this patient without any complications. CONCLUSIONS The electrocardiogram surveillance in patients with myasthenic crisis is essential to detect the occurrence of Takotsubo cardiomyopathy and its complications. Early diagnosis and treatments may decrease mortality and morbidity related with this condition.

Figure 1.

(A) The 12-lead electrocardiogram demonstrated normal sinus rhythm with significant QT prolongation and diffuse deep T wave inversion in all leads (asterisk). (B) The 12-lead electrocardiogram at 3 month after the diagnosis of Takotsubo cardiomyopathy showed significant shortening of QT interval compared to previous electrocardiogram.

Figure 2.

(A) Transthoracic echocardiogram demonstrated basal hyperkinesia and apical akinesia with apical ballooning. Large apical thrombus was noted (asterisk). (B) Transthoracic echocardiogram at 3-month follow-up revealed complete recovery of left ventricular function and no residual apical thrombus.