title: Broken heart syndrome during myasthenic crisis.
abstract: OBJECTIVE
  Myocardial pathology is rarely associated with myasthenia gravis (MG). We describe a case of newly diagnosed MG with decompensated heart failure [stress-induced cardiomyopathy (SICM)] that occurred during the crisis phase.
  
  
  METHODS
  Case report and review of literature.
  
  
  RESULTS
  A 42-year-old woman underwent chemotherapy followed by a transsternal resection of a malignant epithelioid thymoma invading the pericardium. A month after surgical resection, she developed progressive oropharyngeal symptoms with respiratory distress requiring tracheal intubation. Cardiac evaluation on the day of admission showed a normal ejection fraction, which rapidly decreased to 15% on the second hospital day and recovered to 45% after 1 week. Review of the literature revealed 4 myasthenic patients who developed SICM in the crisis phase; all improved with treatment.
  
  
  CONCLUSIONS
  SICM may occur in MG crisis, especially in the presence of malignant thymoma. All previous cases including our patient had improved myocardial function and clinical outcomes.
authors.affiliation: *Department of Neurology, SSM Neurosciences Institute and St. Louis University, St. Louis, MO; and †Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Sikawat
authors.initials: S
authors.lastname: Thanaviratananich
authors.forename: Bashar
authors.initials: B
authors.lastname: Katirji
authors.forename: Amer
authors.initials: A
authors.lastname: Alshekhlee
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D009157:Myasthenia Gravis / Q000150:complications*; D054549:Takotsubo Cardiomyopathy / Q000209:etiology*; D013945:Thymoma / Q000601:surgery; D013953:Thymus Neoplasms / Q000601:surgery