Jose Eduardo Duya, Rodel Buitizon, Kristine Tumabiene, Jose Danilo Diestro, Michael Joseph Agbayani and Richard Henry Tiongco
Fellow in Training, Section of Cardiology, Department of Medicine, University of Philippines- Philippine General Hospital
Posters & Accepted Abstracts: J Neurol Neurophysiol
Myasthenia gravis (MG) is an autoimmune disorder directed against acetylcholine receptors. Despite the absence of these receptors in cardiomyocytes, asymptomatic ECG changes, tachyarrhythmias, myocarditis, and sudden death have been documented. We report two cases of MG presenting with deep diffuse persistent T wave inversions as a marker for possible MG related cardiac disease. A 68 year-old female, diagnosed with MG, post thymectomy for malignant thymoma in 2013, was admitted for progressive weakness, pleuritic chest pain and cough. ECG showed regular sinus rhythm, normal axis, low voltage complexes on limb leads, poor R wave progression, prolonged QT interval, diffuse T wave inversion on all leads. Troponin I level was borderline elevated however, monitoring of troponin was negative. Echocardiography revealed concentric left ventricular hypertrophy with good contractility. ECG monitoring showed deepening diffuse symmetric T wave inversion. Due to the low CAD risk, this was interpreted as non-ischemic and was attributed to MG�s autoimmunity. Antibiotics, pyridostigmine, prednisone and plasmapheresis were given. She remained stable throughout the course. Repeat ECG a month showed normalization of T wave inversion. A 29 year old female was admitted for MG crisis. ECG revealed sinus tachycardia, with upright T waves. On Day eight, patient developed sepsis induced hypotension and repeat ECG showed 2 mm ST elevation on V2-V3 with 3 mm T wave inversion on lateral leads. Serial ECG showed deepening of T wave inversion on V2-V6 (deepest 7 mm). The cardiac enzymes, echocardiogram and electrolytes were normal. With medical management, the patient was discharged. The dynamic ECG changes were attributed to possible immunologic myocarditis, which can present with deep T wave inversions. This case report highlights that clinicians should be aware that MG can present with this ECG feature, albeit seemingly alarming, usually follows a benign course and resolves with the resolution of MG crisis.
Email: joeyduya@gmail.com
