Severe Respiratory Failure and Torsades de Pointes Induced by Disopyramide in a Patient with Myasthenia Gravis

Kayo Hirose; Hiroshi Yamaguchi; Yasushi Oshima; Masahito Choraku; Akira Hirono; Nobuyuki Takamori; Katsuya Tamura

doi:10.2169/internalmedicine.47.0976

CASE REPORTS

Severe Respiratory Failure and Torsades de Pointes Induced by Disopyramide in a Patient with Myasthenia Gravis

Kayo Hirose, Hiroshi Yamaguchi, Yasushi Oshima, Masahito Choraku, Akira Hirono, Nobuyuki Takamori, Katsuya Tamura

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Keywords: disopyramide, myasthenia gravis, long QT syndrome, class 1a anti-arrhythmic drugs

JOURNAL OPEN ACCESS

2008 Volume 47 Issue 19 Pages 1703-1708

DOI https://doi.org/10.2169/internalmedicine.47.0976

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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.

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