Fatih KOÇ, Remzi YILMAZ, Veysel TOSUN, Necmettin KORUCUK, Mustafa Serkan KARAKAŞ

Miyastenia Gravisli Hastada Gelişen Akut ST-segment Elevasyonlu Miyokard İnfarktüsü ve Koroner Diseksiyon Gelişimi: İlk Olgu Sunumu

Miyastenia gravis MG , nöromusküler kavşaktaki asetil kolin reseptörlerinde azalmaya bağlı iskelet kaslarında güçsüzlükle karakterize olan nöromusküler bir hastalıktır. MG’de kardiyovasküler olaylar nadir görülür ve çoğunlukla uygulanan medikasyona bağlıdır. Bu yazıda acil serviste akut inferior STsegment elevasyonlu miyokard infarktüsü saptanan ve primer perkütan girişim ile tedavi edilip stent yerleştirilmesi sonrası koroner diseksiyon gelişen 54 yaşındaki ilk olgu sunulmuştur. Bu olguda gelişen koroner diseksiyonun olası sebeplerinin MG’in klinik seyrine ve tedavide kullanılan antikolinesteraz ilaçlara bağlı olabileceği düşünülmüştür

Anahtar Kelimeler:

Miyastenia gravis, Antikolinesteraz tedavi, Miyokard infarktüsü

Acute Inferior ST-segment Elevation Myocardial Infarction and Coronary Artery Dissection in a Patient With Myasthenia Gravis: First Case Report

Myasthenia gravis MG is a neuromuscular disorder characterized by weakness of skeletal muscles because of a decrease of available acetylcholine receptors at neuromuscular junctions. Cardiovascular adverse events in patients with MG are rare and usually depend on the administered medication. In this case report, we present a case of a 54-year-old MG patient with inferior ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention and coronary artery dissection after stent implantation. To our knowledge, this is the first case report of acute myocardial infarction and coronary artery dissection, quite possibly induced by the anticholinesterase medication used during the clinical course of the disease

Keywords:

Myasthenia gravis, Anticholinesterase medication, Myocardial infarction,

PDF

___

Drachman DB. Myasthenia gravis. N Engl J Med 1994; 330:1797-1810.
Zis P, Dimopoulos S, Markaki V, Tavernarakis A, Nanas S. Non-coronary myocardial infarction in myasthenia gravis: Case report and review of the literature. World J Cardiol 2013; 5: 265-9.
Suzuki M, Yoshii T, Ohtsuka T, Sasaki O, Hara Y, Okura T, Shigematsu Y, Hamada M, Hiwada K. Coronary spastic angina induced by anticholinesterase medication for myasthenia gravis--a case report. Angiology 2000; 51: 1031-34.
Comerci G, Buffon A, Biondi-Zoccai GG, Ramazzotti V, Romagnoli E, Savino M, Rebuzzi AG, Biasucci LM, Loperfido F, Crea F. Coronary vasospasm secondary to hypercholinergic crisis: An iatrogenic cause of acute myocardial infarction in myasthenia gravis. Int J Cardiol 2005; 103: 335-37.
Yasue H, Horio Y, Nakamura N, Fujii H, Imoto N, Sonoda R, Kugiyama K, Obata K, Morikami Y, Kimura T. Induction of coronary artery spasm by acetylcholine in patients with variant angina: Possible role of the parasympathetic nervous system in the pathogenesis of coronaryartery spasm. Circulation 1986; 74:955-63.
Okumura K, Yasue H, Horio Y, Takaoka K, Matsuyama K, Kugiyama K, Fujii H, Morikami Y. Multivessel coronary spasm in patients with variant angina: A study with intracoronary injection of acetylcholine. Circulation 1988;77:535-42.
Drachman DB. Myasthenia gravis; Medical progress. N Engl J Med 1994;330:1797-1810.
Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 1980;288:373-6.