Author/Authors :
Saud Khan, Mohammad Department of Internal Medicine - University of Toledo Medical Center, Toledo, OH, USA , Tiwari, Abhinav Department of Internal Medicine - University of Toledo Medical Center, Toledo, OH, USA , Khan, Zubair Department of Internal Medicine - University of Toledo Medical Center, Toledo, OH, USA , Sharma, Himani Department of Internal Medicine - University of Toledo Medical Center, Toledo, OH, USA , Taleb, Mohammad Department of Internal Medicine and Department of Pulmonary Critical Care - University of Toledo Medical Center, Toledo, OH, USA , Hammersley, Jeffrey Department of Internal Medicine and Department of Pulmonary Critical Care - University of Toledo Medical Center, Toledo, OH, USA
Abstract :
Reversible acetylcholinesterase inhibitors are used as first-line treatment for myasthenia gravis.They improve symptoms by increasing concentration of acetylcholine at the neuromuscular junction and stimulating nicotinic receptors. Serious bradyarrhythmias
can occur from muscarinic stimulation in heart, which in rare cases may progress to asystole. These patients can initially be
managed with hyoscyamine, a muscarinic antagonist. Persistence of bradyarrhythmias even after hyoscyamine treatment may
warrant pacemaker placement. We present a case of 65-year-old female patient who presented with diplopia, dysphagia, and muscle
weakness who was diagnosed with myasthenia gravis. She developed significant sinoatrial node block with prolonged asystole after
starting treatment with pyridostigmine which was successfully treated with hyoscyamine, thus avoiding pacemaker placement.
