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Case Reports in Critical Care
Volume 2017 (2017), Article ID 5702075, 5 pages
Case Report

A Case Report of Recurrent Takotsubo Cardiomyopathy in a Patient during Myasthenia Crisis

1Department of Neurology, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
2Department of Cardiology, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA

Correspondence should be addressed to Raghav Govindarajan

Received 9 July 2017; Revised 8 September 2017; Accepted 27 September 2017; Published 19 October 2017

Academic Editor: Michael J. Cawley

Copyright © 2017 Anusha Battineni et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Patients with myasthenia crisis can develop Takotsubo stress cardiomyopathy (SC) due to emotional or physical stress and high level of circulating catecholamines. We report a patient who developed recurrent Takotsubo cardiomyopathy during myasthenia crisis. Coexisting autoimmune disorders known to precipitate stress cardiomyopathy like Grave’s disease need to be evaluated. Case Report. A 69-year-old female with seropositive myasthenia gravis (MG), Grave’s disease, and coronary artery disease on monthly infusion of intravenous immunoglobulin (IVIG), prednisone, pyridostigmine, and methimazole presented with shortness of breath and chest pain. Electrocardiogram (ECG) showed ST elevation in anterolateral leads with troponemia. Coronary angiogram was unremarkable for occlusive coronary disease with left ventriculogram showing reduced wall motion with apical and mid left ventricle (LV) hypokinesis suggestive of Takotsubo stress cardiomyopathy. Her symptoms were attributed to MG crisis. Her symptoms, ECG, and echocardiographic findings resolved after five cycles of plasma exchange (PLEX). She had another similar episode one year later during myasthenia crisis with subsequent resolution in 10 days after PLEX. Conclusion. Takotsubo cardiomyopathy can be one of the manifestations of myasthenia crisis with or without coexisting Grave’s disease. These patients might benefit from meticulous fluid status and cardiac monitoring while administering rescue treatments like IVIG and PLEX.