Multimodality Evaluation in Cardiovascular Imaging in the Diagnosis of Atypical Cases of Chest Pain: Myasthenia Gravis

Regarding cardiac involvement, the clinical presentation is variable: from asymptomatic conditions, electrocardiogram (ECG) with non-specific abnormalities, presence of arrhythmias, myocarditis and Takotsubo syndrome.4-7 Another form of cardiac involvement is related to anticholinesterase.8 In MG, the number of available Ach receptors is decreased, and the use of anticholinesterase decreases Ach degradation and promotes a greater supply of Ach to the receptors. Frequent adverse effects of this medication are diarrhea, abdominal cramps and nausea. A severe yet less common effect is chest pain. This may mimic an acute coronary syndrome (ACS) caused by the vasoconstriction that Ach is capable of causing in coronary arteries with endothelial dysfunction.