Abnormal electrocardiogram in a patient with amyotrophic lateral sclerosis mimicking myocardial ischaemia

Abstract

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that almost exclusively involves motor neurons although autonomic dysfunction has also been reported. We present an 84-year-old female with no documented history of heart disease, who was admitted with negative T waves in the electrocardiogram precordial leads mimicking myocardial ischaemia. No other abnormalities were shown in the rest of the cardiologic evaluation, suggesting autonomic nervous system dysfunction. A neurophysiological study demonstrated acute and chronic denervation in multiple muscles with normal nerve conduction studies, confirming ALS diagnosis. Previous studies have shown that subclinical sympathetic hyperfunction and parasympathetic hypofunction might result in cardiovascular dysfunction in ALS patients. It is important to detect disturbances of autonomic cardiac control because this dysfunction may influence survival and quality of life, leading to a decrease in life expectancy in ALS patients. This Case Report may support the impairment of cardiac autonomic control in patients with ALS.

Keywords: Amyotrophic lateral sclerosis; Autonomic nervous system diseases; Electrocardiography; Myocardial ischemia; Cardiac catheterization

Core tip: A few cases showing electrocardiogram (ECG) abnormalities in amyotrophic lateral sclerosis (ALS) patients have been previously reported suggesting an autonomic disturbance in ALS. We present an ALS patient with abnormal ECG mimicking myocardial ischaemia, in whom both coronary disease and cardiac anatomic damage were ruled out supporting the autonomic nervous system involvement in this mainly motor neuron disease.