How does the myasthenic crisis manifest? Treatment
Any crisis is a state of a person in which the course of a disease suddenly and sharply worsens, and the life-threatening symptomatology grows very quickly. Myasthenic and cholinergic crises, which are the companions of myasthenia gravis, are dangerous because the patient can lose his breath and stop the heart. Sometimes a person's life is calculated literally by minutes, for which doctors or people in the vicinity should be in time to provide the proper help. Why is there an exacerbation of a seemingly non-deadly myasthenia gravis? We offer a simple, understandable language for anyone to talk about what everyone should know: the causes that cause myasthenic and cholinergic crises, the clinic, emergency help to those with whom this misfortune happened. Perhaps someone near us, if suddenly in transport or just on the street it becomes bad, the information in this article will help save lives.
The story of the crisis begins with an explanation of the concept of myasthenia. Sometimes, others take this disease for simulation, since those suffering from myasthenia constantly complain of rapid fatigue, lethargy, unable to perform any physical work, only the easiest.
Myasthenic cristae develops against the background of a common disease and has similar symptoms, only manifesting to a much greater extent, which earlier led to the death of approximately 40% of patients. Now, if treatment is begun without delay, a lethal outcome can be avoided. I want to note that myasthenia graze 10 people for every 100 thousand citizens of the Earth, and women suffer it 3 times more often than men. To manifest myasthenia gravis can already in childhood, but such cases are rare. In general, it is observed in persons from 20 years old and to old age.
Symptoms of myasthenia gravis
Without myasthenia gravis, if it is present in a person, a myasthenic crisis can not occur. However, sometimes other diseases with similar symptoms, for example, such as the aforementioned lethargy, weakness, increased fatigue, are sometimes taken for him. Additional symptoms with myasthenia gravis:
- eyelids lowering, most noticeable towards evening and decreasing in the mornings after an overnight rest;
- double vision;
- exhaustion, high fatigue after normal for other people loads, for example, climbing the stairs;
- initial bulbar signs( appearance of a nasal voice after eating and a long conversation, difficulty in pronouncing individual letters);
- dynamics of bulbar signs( difficulty in swallowing, frequent pinches);
- vegetative disorders( intestinal paresis, tachycardia);
- mimic signs( on the forehead very deep wrinkles, characteristic facial expression);
- difficulty in keeping the head;
- difficulty walking.
Distinctive feature of myasthenia gravis - all of the above manifestations intensify after physical exertion and in the evening, and after a full rest are reduced or completely disappear.
Symptomatic of the myasthenic crisis
If a person suffers from myasthenia gravis, under certain circumstances he may experience a myasthenic crisis. Symptoms of the underlying disease, especially such as tachycardia, high fatigue of vital muscles( respiratory, cardiac), drooling, while increasing. Also for the crisis are the following manifestations:
- paralysis of swallowing muscles and tongue, which can cause mucus, saliva, food to enter the respiratory tract;
- a strong excitement and panic due to lack of air;
- cold sweat;
- sometimes spontaneous urination and / or defecation;
- loss of consciousness;
- dry skin;
- blood pressure jumps;
- dilated pupils;
- acute heart failure, that is, a violation in the work of the heart.
Myasthenic crisis occurs in several degrees:
- lightning fast.
Differences are in the strength of the manifestation of the above symptoms. Especially dangerous are the severe and lightning crisis, in which a person quickly, literally in a couple of minutes, develops a weakness of the respiratory and swallowing muscles. Breathing first becomes rapid, the face turns red, the pressure jumps up, the pulse reaches about 160 beats per minute. Then the breath begins to break, it may disappear altogether, the face turns blue( in medicine this is called cyanosis), the pressure drops, the pulse is hardly probed.
Causes of myasthenic crisis
Myasthenia gravis can be both congenital and acquired. The first arises because of mutations in the genes. The second develops if a person has:
- problems with the thymus gland;
- some forms of cancer( in particular, breasts, lungs, ovaries);
- lethargic encephalitis.
Against the backdrop of these diseases, the crisis of myasthenic can develop in such cases:
- acute infectious diseases, including ARVI, influenza, bronchitis;
- strong psychological stress;
- high physical load;
- taking certain medications( in particular, tranquilizers);
- hormonal disorders;
- admission of patients with myasthenia gravis receiving pills, violation of the course of treatment.
Myasthenic crisis and cholinergic often manifest in parallel, because of which there are errors in differentiation and, consequently, in treatment. However, these two somewhat similar external manifestations of the state are caused by different causes and have a different etiology.
So, with the myasthenic crisis, the density of the cholinergic receptors of the membrane decreases due to their destruction, and the remaining ones change their functions. And with the cholinergic crisis, there is excessive activation of the cholinergic receptors( nicotinic and / or muscarinic).This process is started by the administration of drugs for the treatment of myasthenia gravis in elevated doses, as well as the means prohibited for this disease.
Diagnosing this crisis is not easy, since its main symptoms coincide with the myasthenic. To help correctly determine what happens to a person, such a feature in his condition, characteristic of a cholinergic crisis, can appear: the patient shows signs of intoxication: the stomach hurts, vomiting opens, diarrhea begins. For the myasthenic crisis, everything is common, except for these symptoms.
The second feature of the cholinergic crisis is that the symptoms of myasthenia gravis worsen without physical exertion, but after taking anticholinesterase medications.
This is the most dangerous for health and life pathology. It combines the crisis of myasthenic and cholinergic, presenting immediately all the symptoms noted in both states. This makes it difficult to correctly diagnose, but even more - treatment, because those drugs that save from the myasthenic crisis, cholinergic aggravate even more. With mixed crises, two flow phases are distinguished:
1. Myasthenic .Patients exhibit pronounced bulbar disorders, breathing problems, motor activity causes fatigue, but no drug reactions( "Clamin", "Proserin") cause negative reactions.
2. Cholinergic , characterized by symptoms of intoxication.
Practice has shown that mixed crises most often occur in people who have already suffered a crisis in myasthenia gravis.
Suspected mixed crisis can be due to such features of manifestation:
- the patients clearly have difficulty breathing and bulbar violation, and the motor function of the extremities is changed little;
- taking drugs unequally reduces pathological symptoms, for example improves motor activity and almost does not help to stabilize breathing.
In order not to be mistaken and to quickly provide effective help in case of myasthenic crisis, it is important to correctly diagnose a patient. As noted above, some symptoms of the myasthenic crisis may be present in diseases that are not related to myasthenia gravis( eg, difficulty breathing, heart rhythm failure).The symptomatology of the cholinergic crisis is similar to that which occurs with intoxication and some problems with the digestive system. If there is an accompanying person with the patient, who is able to give information about the presence of his myasthenia gravis and about the medications he takes, the diagnosis is much simplified. To differentiate the type of crisis, doctors perform a proserin test.
Special difficulties in diagnosing are observed with a mixed crisis. For the purpose of an unmistakable determination of its first phase, a clinical analysis of the patient's condition is carried out, as well as an electrophysiological evaluation of the effect obtained from taking anticholinesterase medications.
The very presence of a male myasthenia gravis( before the onset of a crisis) is detected by electromyography, computed tomography, pharmacological and immunological tests.
Emergency care for myasthenic and cholinergic crisis
If the patient's myasthenia gravely suddenly worsened( the crisis came), the account of life goes on for minutes. The main thing that must be done by others is to immediately call an ambulance. Unfortunately, in our reality there are situations when specialized assistance is late. In what way can you help a dying person? First, try to ensure his breathing, remove the mucus from his throat. According to the rules, those suffering from myasthenia gravis should have a note about the presence of this disease, as well as medicines( for example, "Proserin") and a syringe. If there is no possibility of a fast arrival, the person with a myasthenic crisis needs to be injected according to the information in the note.
Prepared physicians are required to urgently hospitalize the patient, and in intensive care, where intensive emergency therapy is carried out:
- ensuring airway patency;
- oxygen supply;
- hardware artificial ventilation.
If the patient has no symptoms of a cholinergic crisis( vomiting, diarrhea), the following drugs are administered: "Prozerin", "Atropine".In the presence of symptoms of intoxication emergency therapy is only in the artificial ventilation of the lungs and in injections of such drugs: "Atropine", "Immunoglobulin", as well as some other medical products according to indications.
If a person has a myasthenic crisis, treatment after emergency treatment is performed based on clinical and laboratory tests, analyzes and dynamics of the disease. Ventilation( i.e., artificial ventilation of the lungs) depending on the clinical picture of the patient's condition, as well as on the presence of oxygen in the blood can be carried out for up to six days, but if the patient has a positive reaction to Prozerin after 16 or more hours, the ventilator is canceled. In general, the procedure of ventilation is very serious and responsible, requiring continuous control of respirators,% composition of gases in the blood, circulation, temperature, balance of fluids in the body and other things.
An excellent method, dealing with all types of crises in myasthenia gravis, is exchange plasmapheresis. In this case, blood is taken from the central( or ulnar) vein, it is centrifuged, the plasma is changed to donor or artificial. This method gives excellent results - in a couple of hours the patient's condition is improving significantly. Plasmapheresis is performed for 7 to 14 days.
One of the stages of treatment is drug therapy. According to the indications, immunoglobulins, antioxidants, anticholinesterase drugs are attributed to the patients, and antibiotics if there are inflammatory processes.
Prognosis and prophylaxis of
Thirty-forty years ago, lethal outcomes in myasthenia patients with exacerbation of the disease occurred quite often. Now the mortality rate has been reduced by 12 times. It is necessary to understand that sometimes the life of a person depends on our actions with you, who has a myasthenic crisis. Emergency care must be provided very quickly. Therefore, if suddenly on the street, in transport, anywhere we see a man beginning to suffocate, the ambulance should be called immediately.
Myasthenia patients also have to follow a number of measures to prevent a crisis:
- to be under the supervision of a doctor and strictly follow the prescribed treatment;
- avoid overwork, nervous breakdowns;
- if possible, be protected from infectious diseases;
- do not expose your body to intoxication;
- in the diet include foods rich in potassium( for example, potato dishes, raisins).