Hsu CW, Chang CC, Lin CS. Intraoperative cardiogenic shock induced by refractory coronary artery spasm in a patient with myasthenia gravis: A case report. World J Clin Cases 2023; 11(36): 8589-8594 [PMID: 38188219 DOI: 10.12998/wjcc.v11.i36.8589]
Corresponding Author of This Article
Chao-Shun Lin, MD, PhD, Associate Professor, Department of Anesthesiology, Taipei Medical University Hospital, No. 252 WuXing Street, Taipei 110, Taiwan. lin.soon@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2023; 11(36): 8589-8594 Published online Dec 26, 2023. doi: 10.12998/wjcc.v11.i36.8589
Intraoperative cardiogenic shock induced by refractory coronary artery spasm in a patient with myasthenia gravis: A case report
Cheng-Wei Hsu, Chuen-Chau Chang, Chao-Shun Lin
Cheng-Wei Hsu, Chuen-Chau Chang, Chao-Shun Lin, Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan
Chao-Shun Lin, Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
Author contributions: Hus CW and Chang CC interpreted the patient data and wrote the draft of the manuscript; Lin CS wrote the manuscript as the corresponding author; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent for publication of the clinical details and images was obtained from the relative of the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao-Shun Lin, MD, PhD, Associate Professor, Department of Anesthesiology, Taipei Medical University Hospital, No. 252 WuXing Street, Taipei 110, Taiwan. lin.soon@gmail.com
Received: October 26, 2023 Peer-review started: October 26, 2023 First decision: November 22, 2023 Revised: November 24, 2023 Accepted: December 7, 2023 Article in press: December 7, 2023 Published online: December 26, 2023
Abstract
BACKGROUND
Coronary artery spasm (CAS) is a rare but critical condition during surgery. Clinical manifestations can vary from only subtle electrocardiography change to sudden death. In this case report, we present the case of a patient with myasthenia gravis (MG) who developed refractory CAS-related cardiogenic shock during thymoma surgery.
CASE SUMMARY
A 61-year-old man had a history of cigarette smoking and coronary artery disease with a bare metal stent placed. Three months ago, he suffered from coronary spasms, with three vessels involved, after surgery for cervical spine injury. He started having progressive dysphagia 4 wk prior and was diagnosed with MG via serologic tests, and computed tomography declared a thymoma in the anterior mediastinum. After the symptoms of MG subsided, he was referred for thymectomy. The operation was uneventful until the closing of the sternal wound. Electrocardiography showed sudden onset ST elevation, followed by ventricular tachycardia and severe hypotension. Cardiopulmonary cerebral resuscitation was initiated immediately with electrical defibrillation, extracorporeal membrane oxygenation was performed due to refractory cardiogenic shock, and the patient was transferred to an angiography room. Angiography showed diffuse CAS with three vessels involved. Intracoronary isosorbide dinitrate and adenosine were administered, and then the patient was transferred to the intensive care unit.
CONCLUSION
Our case highlights the importance of being prepared for clinical situations such as the one described here and suggests the necessity of developing an appropriate anesthesia plan that includes proactive analgesia and preemptive coronary vasodilators.
Core Tip: In previous literature reviews, it has been noted that a correlation exists between myasthenia gravis (MG) and cardiac complications, such as coronary artery spasm (CAS), which frequently manifests as chest pain in affected patients. Nevertheless, when MG coincides with thymoma, surgical intervention is often necessary. The diagnosis of CAS while the patient is under general anesthesia poses a considerable challenge. Our case report aims to underscore scenarios of this nature and suggests an optimal anesthesia strategy in such cases.
