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Pyridostigmine Induced Prolonged Asystole in a Patient with Myasthenia Gravis Successfully Treated with Hyoscyamine

Reversible acetylcholinesterase inhibitors are used as first-line treatment for myasthenia gravis. They improve symptoms by increasing concentration of acetylcholine at the neuromuscular junction and stimulating nicotinic receptors. Serious bradyarrhythmias can occur from muscarinic stimulation in h...

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Autores principales: Khan, Mohammad Saud, Tiwari, Abhinav, Khan, Zubair, Sharma, Himani, Taleb, Mohammad, Hammersley, Jeffrey
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5446877/
https://www.ncbi.nlm.nih.gov/pubmed/28589042
http://dx.doi.org/10.1155/2017/6956298
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author Khan, Mohammad Saud
Tiwari, Abhinav
Khan, Zubair
Sharma, Himani
Taleb, Mohammad
Hammersley, Jeffrey
author_facet Khan, Mohammad Saud
Tiwari, Abhinav
Khan, Zubair
Sharma, Himani
Taleb, Mohammad
Hammersley, Jeffrey
author_sort Khan, Mohammad Saud
collection PubMed
description Reversible acetylcholinesterase inhibitors are used as first-line treatment for myasthenia gravis. They improve symptoms by increasing concentration of acetylcholine at the neuromuscular junction and stimulating nicotinic receptors. Serious bradyarrhythmias can occur from muscarinic stimulation in heart, which in rare cases may progress to asystole. These patients can initially be managed with hyoscyamine, a muscarinic antagonist. Persistence of bradyarrhythmias even after hyoscyamine treatment may warrant pacemaker placement. We present a case of 65-year-old female patient who presented with diplopia, dysphagia, and muscle weakness who was diagnosed with myasthenia gravis. She developed significant sinoatrial node block with prolonged asystole after starting treatment with pyridostigmine which was successfully treated with hyoscyamine, thus avoiding pacemaker placement.
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spelling pubmed-54468772017-06-06 Pyridostigmine Induced Prolonged Asystole in a Patient with Myasthenia Gravis Successfully Treated with Hyoscyamine Khan, Mohammad Saud Tiwari, Abhinav Khan, Zubair Sharma, Himani Taleb, Mohammad Hammersley, Jeffrey Case Rep Cardiol Case Report Reversible acetylcholinesterase inhibitors are used as first-line treatment for myasthenia gravis. They improve symptoms by increasing concentration of acetylcholine at the neuromuscular junction and stimulating nicotinic receptors. Serious bradyarrhythmias can occur from muscarinic stimulation in heart, which in rare cases may progress to asystole. These patients can initially be managed with hyoscyamine, a muscarinic antagonist. Persistence of bradyarrhythmias even after hyoscyamine treatment may warrant pacemaker placement. We present a case of 65-year-old female patient who presented with diplopia, dysphagia, and muscle weakness who was diagnosed with myasthenia gravis. She developed significant sinoatrial node block with prolonged asystole after starting treatment with pyridostigmine which was successfully treated with hyoscyamine, thus avoiding pacemaker placement. Hindawi 2017 2017-05-14 /pmc/articles/PMC5446877/ /pubmed/28589042 http://dx.doi.org/10.1155/2017/6956298 Text en Copyright © 2017 Mohammad Saud Khan et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Khan, Mohammad Saud
Tiwari, Abhinav
Khan, Zubair
Sharma, Himani
Taleb, Mohammad
Hammersley, Jeffrey
Pyridostigmine Induced Prolonged Asystole in a Patient with Myasthenia Gravis Successfully Treated with Hyoscyamine
title Pyridostigmine Induced Prolonged Asystole in a Patient with Myasthenia Gravis Successfully Treated with Hyoscyamine
title_full Pyridostigmine Induced Prolonged Asystole in a Patient with Myasthenia Gravis Successfully Treated with Hyoscyamine
title_fullStr Pyridostigmine Induced Prolonged Asystole in a Patient with Myasthenia Gravis Successfully Treated with Hyoscyamine
title_full_unstemmed Pyridostigmine Induced Prolonged Asystole in a Patient with Myasthenia Gravis Successfully Treated with Hyoscyamine
title_short Pyridostigmine Induced Prolonged Asystole in a Patient with Myasthenia Gravis Successfully Treated with Hyoscyamine
title_sort pyridostigmine induced prolonged asystole in a patient with myasthenia gravis successfully treated with hyoscyamine
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5446877/
https://www.ncbi.nlm.nih.gov/pubmed/28589042
http://dx.doi.org/10.1155/2017/6956298
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