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Pyridostigmine-induced high grade SA-block in a patient with myasthenia gravis

Patient: Female, 70 Final Diagnosis: SA block induced by pyridostigmine Symptoms: Asymptomatic Medication: Pyridostigmine Clinical Procedure: Pacemaker insertion Specialty: Electrophysiology OBJECTIVE: Unusual clinical course BACKGROUND: Myasthenia gravis requires a long-term treatment with a parasy...

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Autores principales: Said, Sarmad, Cooper, Chad J., Alkhateeb, Haider, Elhanafi, Sherif, Bizet, Jorge, Gosavi, Sucheta, Abedin, Zainul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775617/
https://www.ncbi.nlm.nih.gov/pubmed/24046803
http://dx.doi.org/10.12659/AJCR.889484
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author Said, Sarmad
Cooper, Chad J.
Alkhateeb, Haider
Elhanafi, Sherif
Bizet, Jorge
Gosavi, Sucheta
Abedin, Zainul
author_facet Said, Sarmad
Cooper, Chad J.
Alkhateeb, Haider
Elhanafi, Sherif
Bizet, Jorge
Gosavi, Sucheta
Abedin, Zainul
author_sort Said, Sarmad
collection PubMed
description Patient: Female, 70 Final Diagnosis: SA block induced by pyridostigmine Symptoms: Asymptomatic Medication: Pyridostigmine Clinical Procedure: Pacemaker insertion Specialty: Electrophysiology OBJECTIVE: Unusual clinical course BACKGROUND: Myasthenia gravis requires a long-term treatment with a parasympathomimetic agent, which may result in bradycardia and asystole. Pharmacologic treatment with a reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH) and Methylprednisolone is seen to improve the muscular symptoms but may reinforce potential bradyarrhythmias. This potential side effect can be treated with the levo isomer of atropine, Hyoscyamine, or Glycopyrollate in an intact conduction system. CASE REPORT: A 70-year old Caucasian female patient with a family history of myasthenia gravis presented with mild weakness of the bilateral facial muscles, moderate dysarthria, dysphagia, diplopia predominantly on the right side and difficulty tracking ocular movements bilaterally. The treatment with pharmacological agents was initiated. Subsequently she developed asymptomatic bradycardia and SA-block. An improvement on Hyoscyamine failed to appear. A dual chamber pacemaker was placed. CONCLUSIONS: In symptomatic or asymptomatic bradycardia with significant high grade SA-block in patients with myasthenia gravis the insertion of a permanent pacemaker can be the definitive solution.
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spelling pubmed-37756172013-09-17 Pyridostigmine-induced high grade SA-block in a patient with myasthenia gravis Said, Sarmad Cooper, Chad J. Alkhateeb, Haider Elhanafi, Sherif Bizet, Jorge Gosavi, Sucheta Abedin, Zainul Am J Case Rep Articles Patient: Female, 70 Final Diagnosis: SA block induced by pyridostigmine Symptoms: Asymptomatic Medication: Pyridostigmine Clinical Procedure: Pacemaker insertion Specialty: Electrophysiology OBJECTIVE: Unusual clinical course BACKGROUND: Myasthenia gravis requires a long-term treatment with a parasympathomimetic agent, which may result in bradycardia and asystole. Pharmacologic treatment with a reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH) and Methylprednisolone is seen to improve the muscular symptoms but may reinforce potential bradyarrhythmias. This potential side effect can be treated with the levo isomer of atropine, Hyoscyamine, or Glycopyrollate in an intact conduction system. CASE REPORT: A 70-year old Caucasian female patient with a family history of myasthenia gravis presented with mild weakness of the bilateral facial muscles, moderate dysarthria, dysphagia, diplopia predominantly on the right side and difficulty tracking ocular movements bilaterally. The treatment with pharmacological agents was initiated. Subsequently she developed asymptomatic bradycardia and SA-block. An improvement on Hyoscyamine failed to appear. A dual chamber pacemaker was placed. CONCLUSIONS: In symptomatic or asymptomatic bradycardia with significant high grade SA-block in patients with myasthenia gravis the insertion of a permanent pacemaker can be the definitive solution. International Scientific Literature, Inc. 2013-09-11 /pmc/articles/PMC3775617/ /pubmed/24046803 http://dx.doi.org/10.12659/AJCR.889484 Text en © Am J Case Rep, 2013 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License
spellingShingle Articles
Said, Sarmad
Cooper, Chad J.
Alkhateeb, Haider
Elhanafi, Sherif
Bizet, Jorge
Gosavi, Sucheta
Abedin, Zainul
Pyridostigmine-induced high grade SA-block in a patient with myasthenia gravis
title Pyridostigmine-induced high grade SA-block in a patient with myasthenia gravis
title_full Pyridostigmine-induced high grade SA-block in a patient with myasthenia gravis
title_fullStr Pyridostigmine-induced high grade SA-block in a patient with myasthenia gravis
title_full_unstemmed Pyridostigmine-induced high grade SA-block in a patient with myasthenia gravis
title_short Pyridostigmine-induced high grade SA-block in a patient with myasthenia gravis
title_sort pyridostigmine-induced high grade sa-block in a patient with myasthenia gravis
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775617/
https://www.ncbi.nlm.nih.gov/pubmed/24046803
http://dx.doi.org/10.12659/AJCR.889484
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