Cor Vasa 2025, 67(Suppl.3):80-82 | DOI: 10.33678/cor.2025.017

From weak knees to a troubled heart - a case of severe autonomic dysfunction in Guillain-Barré syndrome

Adriana Pacheco^a, Leandra Fagundes^b, José Beato Coelho^c, Raquel Ferreira^a, Ana Briosa^a

^a Cardiology Department, Unidade Local de Saúde da Região de Aveiro, Aveiro, Portugal

^b Neurology Department, Unidade Local de Saúde de Coimbra, Coimbra, Portugal

^c Neurology Department, Unidade Local de Saúde da Região de Aveiro, Aveiro, Portugal

Guillain-Barré Syndrome (GBS) is an autoimmune inflammatory disease of the peripheral nervous system, often preceded by respiratory or gastrointestinal infection. A serious complication is autonomic dysfunction, particularly cardiovascular, manifesting as blood pressure fluctuations, arrhythmias, and electrocardiographic changes. Myocardial infarction is rare and its diagnosis may be challenging in this setting. We report the case of a 67-year-old man with a recent upper respiratory infection who presented with progressive weakness of the lower limbs. He rapidly developed tetraparesis, dysphagia, respiratory failure, and acute pulmonary edema, accompanied by electrocardiographic changes consistent with acute coronary syndrome and elevated troponin. However, coronary angiography revealed no obstructive disease, while echocardiography showed transient left ventricular dysfunction. The patient was treated with intravenous immunoglobulin and intensive supportive measures. Neurophysiological and cerebrospinal fluid studies later confirmed GBS. His course was prolonged, complicated by nosocomial infections, but he achieved partial neurological recovery and full recovery of left ventricular systolic function. This case highlights the importance of careful cardiovascular monitoring in patients with GBS, as autonomic dysfunction may present with acute coronary syndrome-like features and significantly influence prognosis.

Keywords: Acute coronary syndrome, Autonomic dysfunction, Guillain-Barré syndrome

Received: January 6, 2025; Revised: January 6, 2025; Accepted: January 24, 2025; Prepublished online: August 14, 2025; Published: September 1, 2025  Show citation