CARDIAC REHABILITATION FOR A PATIENT WITH MYASTHENIA GRAVIS AFTER CORONARY BYPASS GRAFTING USING BILATERAL INTERNAL MAMMARY ARTERIES. A clinical case

Abstract. Introduction. Myasthenia gravis is an autoimmune neuromuscular disease mostly characterized by the formation of antibodies to postsynaptic acetylcholine receptors, leading to weakness aggravated by physical activity. Due to the high prevalence of coronary artery disease worldwide, there is a high probability of its development in patients with myasthenia gravis. Physical training in patients after acute coronary syndrome has proven efficacy in improving quality of life and the outcome. Currently, there is a lack of research in the safety of physical training in myasthenia gravis, so cardiac rehabilitation of these patients is a unique challenge for clinicians. Aim of the study was to evaluate the effect of rehabilitation measures in a patient with myasthenia gravis after coronary bypass grafting using bilateral internal mammary arteries at the inpatient stage of medical rehabilitation. Materials and Methods. A clinical case of a female patient after coronary bypass grafting using bilateral internal mammary arteries is presented, which has been observed for 31 years due to myasthenia gravis (G70.0). The patient was examined by the specialists of a multidisciplinary rehabilitation team, using clinical, laboratory, and instrumental research methods. After establishing the rehabilitation diagnosis and potential, an individual medical rehabilitation plan was developed, which, against the background of drug therapy, included: Electrocardiogram-guided aerobic physical training, laser therapy, and occupational therapy. Results of the rehabilitation measures were assessed using the six-minute walk test (m), the Functional Independence Measurement scale (points), and the QMGS (quantitative myasthenia gravis score for the assessment of the severity of clinical myasthenia symptoms) scale. Results and Discussion. The patient tolerated 5 sessions of aerobic physical training well, demonstrating a noticeable improvement in aerobic capacity, endurance, and physical activity test results. No side effects were noted. Conclusions. Personalized physical training programs are feasible and effective in cardiac rehabilitation of patients with myasthenia gravis. Further research is reasonable and necessary in the rehabilitation of cardiac patients with concomitant autoimmune neuromuscular disease.