Severe respiratory failure and torsades de pointes induced by disopyramide in a patient with myasthenia gravis.
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.
Hirose
Kayo
K
Health Insurance Naruto Hospital. rannrann5656@yahoo.co.jp
Yamaguchi
Hiroshi
H
Oshima
Yasushi
Y
Choraku
Masahito
M
Hirono
Akira
A
Takamori
Nobuyuki
N
Tamura
Katsuya
K
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*
D000889:Anti-Arrhythmia Agents; D018680:Cholinergic Antagonists; D004206:Disopyramide