Takotsubo Cardiomyopathy in Patients with Myasthenia Gravis, 2023

Background: Myasthenia gravis associated with takotsubo cardiomyopathy (broken heart syndrome) is a rare condition but a life threatening. Broken heart syndrome is reversible apical ballooning like dilation of left ventricle related to stress. Method: This is a systematic review of previously reported cases of patients with myasthenia gravis developed takotsubo cardiomyopathy, worldwide 2003-2023, pubmed and google scholar, to analyze and find out the definitive treatment and ways of prevention from it. Results: Cases reported previously indicate that takotsubo cardiomyopathy developed in patients with myasthenia gravis during myasthenic crisis in the second day of admission with worsened dyspnea, low ejection fraction, short PR - interval, QT-prolongation and T wave inversion on electrocardiogram; most cases have been occurred in female, and most cases were of age of more than 15 years, especially in presence of thymectomy due to malignant thymoma; some cases have been associated with diabetes mellitus and low frequency smoking history; most cases have been improved with anticholinergic (pyridostigmine) and plasma exchange, NSAIDs (prednisone), and immunoglobulines for myasthenia gravis, dobutamine for takotsubo cardiomyopathy, and ventilator support for respiratory events from myasthenia gravis. Inotropes and vasopressor have been led to poor outcomes; it has been hypothesized that exess catecholamin stimulation cause stress on cardiac muscles presented as takotsubo cardiomyopathy (stress related cardiomyopathy); most cases have been occurred in European and American decent. Conclusion: As physical and emotional stress cause takotsubo cardiomyopathy, they are also a risk factor for developing myasthenia gravis, so avoiding stressful conditions is a prevention, and monitoring cardiac manifestation in myasthenic crisis’s patients with cardiac MRI is very important.