title: Severe respiratory failure and torsades de pointes induced by disopyramide in a patient with myasthenia gravis.
abstract: Class 1a anti-arrhythmic drugs are often used for the treatment of atrial fibrillation (AF), but it is not well known that myasthenia gravis (MG)-like symptoms can be generated by their anti-cholinergic effects. We had a patient with MG who developed symptomatic MG aggravation after AF treatment with disopyramide. Symptomatic MG aggravation was followed by Takotsubo-shaped cardiomyopathy, QT prolongation, and torsades de pointes. We suggest that the anti-cholinergic effects of disopyramide can induce MG crisis and should therefore be carefully considered when disopyramide is used to treat AF in patients with MG.
authors.affiliation: Health Insurance Naruto Hospital. rannrann5656@yahoo.co.jp
authors.forename: Kayo
authors.initials: K
authors.lastname: Hirose
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oshima
authors.forename: Masahito
authors.initials: M
authors.lastname: Choraku
authors.forename: Akira
authors.initials: A
authors.lastname: Hirono
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takamori
authors.forename: Katsuya
authors.initials: K
authors.lastname: Tamura
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000209:etiology; D018680:Cholinergic Antagonists / Q000009:adverse effects; D004206:Disopyramide / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000209:etiology; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications / Q000188:drug therapy*; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D016171:Torsades de Pointes / Q000139:chemically induced*
chemical_list: D000889:Anti-Arrhythmia Agents; D018680:Cholinergic Antagonists; D004206:Disopyramide