Journal of basic and clinical physiology and pharmacology · 2025
Atrioventricular block and myastenia gravis. A case report and review of the literature.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Lombardi Anna, Murru Francesco, Atripaldi Luigi Giuseppe, D'Argenzio Carmine, Verdoliva Rita, Iannibelli Giordana G, Canitano Claudia, De Luca Mariarosaria, Cudemo Giuseppe, Lucci Rosa, Salzano Andrea, Marra Alberto M, Arcopinto Michele, Cittadini Antonio
Аннотация
OBJECTIVES: Myasthenia gravis (MG) is a chronic autoimmune disease primarily affecting skeletal muscles, though cardiac involvement, particularly arrhythmias, may occur, especially in severe cases or in patients with thymoma.
CASE PRESENTATION: We report the case of a 62-year-old male with AchR-Ab-positive MG, without thymoma, who developed an advanced atrioventricular block requiring pacemaker implantation. Cardiac manifestations in MG can result from either the disease itself - through myocarditis, autoantibodies and autonomic dysfunction - or as a side effect of treatments such as pyridostigmine and immunosuppressants. Management strategies include considering discontinuation of pyridostigmine or using hyoscyamine to assess potential drug-induced bradyarrhythmias before proceeding with permanent pacing.
CONCLUSIONS: This case highlights the diagnostic challenges in distinguishing iatrogenic from autoimmune cardiac complications and emphasizes the importance of cardiovascular monitoring in MG patients, especially those presenting with cardiac symptoms or EKG abnormalities. Early recognition and appropriate intervention are crucial to improve outcomes and quality of life.
CASE PRESENTATION: We report the case of a 62-year-old male with AchR-Ab-positive MG, without thymoma, who developed an advanced atrioventricular block requiring pacemaker implantation. Cardiac manifestations in MG can result from either the disease itself - through myocarditis, autoantibodies and autonomic dysfunction - or as a side effect of treatments such as pyridostigmine and immunosuppressants. Management strategies include considering discontinuation of pyridostigmine or using hyoscyamine to assess potential drug-induced bradyarrhythmias before proceeding with permanent pacing.
CONCLUSIONS: This case highlights the diagnostic challenges in distinguishing iatrogenic from autoimmune cardiac complications and emphasizes the importance of cardiovascular monitoring in MG patients, especially those presenting with cardiac symptoms or EKG abnormalities. Early recognition and appropriate intervention are crucial to improve outcomes and quality of life.