Nag DS, Chatterjee A, Mahanty PR, Sam M, Bharadwaj MK. Perioperative cardiac risks in myasthenia gravis. World J Clin Cases 2024; 12(13): 2147-2150 [PMID: 38808348 DOI: 10.12998/wjcc.v12.i13.2147]
Corresponding Author of This Article
Deb Sanjay Nag, MBBS, MD, Doctor, Department of Anaesthesiology, Tata Main Hospital, C Road West, Northern Town, Bistupur, Jamshedpur 831001, India. ds.nag@tatasteel.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Editorial
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/
Deb Sanjay Nag, Abhishek Chatterjee, Pratap Rudra Mahanty, Merina Sam, Murari Kumar Bharadwaj, Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
Abhishek Chatterjee, Pratap Rudra Mahanty, Department of Anaesthesiology, Manipal Tata Medical College, Jamshedpur 831017, India
Author contributions: Nag DS and Chatterjee A designed the overall concept and outline of the manuscript; Mahanty PR, Sam M, and Bharadwaj MK contributed to the discussion and design of the manuscript; All authors contributed to the writing, and editing the manuscript and review of literature.
Conflict-of-interest statement: The authors declare no conflict of interest.
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: Deb Sanjay Nag, MBBS, MD, Doctor, Department of Anaesthesiology, Tata Main Hospital, C Road West, Northern Town, Bistupur, Jamshedpur 831001, India. ds.nag@tatasteel.com
Received: December 19, 2023 Revised: February 23, 2024 Accepted: April 7, 2024 Published online: May 6, 2024 Processing time: 128 Days and 1 Hours
Abstract
Myasthenia gravis (MG) is an autoimmune disorder that affects the neuromuscular junction. The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors (AChRs), which results in qualitative and quantitative reductions in the availability of functional AChRs. Cardiac muscles are also affected, resulting in various perioperative cardiac complications. Antistriational antibodies are commonly reported in MG cases with cardiac involvement. In the presence of thymoma, the prevalence of cardiac manifestations in patients with MG increases to approximately 10%-15%. Cardiac involvement in MG may range from asymptomatic electrocardiogram changes to ventricular tachycardia, myocarditis, conduction disorders, heart failure, and sudden death. Increased incidence of atrial fibrillation, ventricular and supraventricular extra systoles, and prolonged QTc have also been reported in patients with MG. Clinicians should consider the evaluation of autonomic dysfunction and risk of cardiovascular disease in patients with MG.
Core Tip: Current evidence shows that elderly patients with myasthenia gravis (MG) are more prone to developing perioperative cardiac complications. As healthcare professionals refine and evolve screening methods to identify patients with MG at risk of developing perioperative cardiac events due to autonomic dysfunction, the integration of screening for antistriational antibodies becomes crucial. In addition, assessing left ventricular function in the preoperative period may result in successful outcomes in these patients.
