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Background Takayasu’s arteritis is a chronic vasculitis of unknown etiology affecting large vessels. Coronary involvement is rare and myocardial infarction as a presenting symptom has only been described in case reports. Case We report a case of a 19 year old female diagnosed with Takayasu’s arteritis 2 years prior who came in due to chest pain and heart failure symptoms. ECG showed diffuse ischemia with ST elevation of the inferior wall. Coronary angiogram showed 3 vessel disease with left main involvement. Patient was started on high dose steroids. She then developed an acute stroke in the right posterior cerebral artery territory. She improved with Methylprednisolone pulse therapy and oral methotrexate. She was discharged on Prednisone, Methotrexate and cardiac medications and is stable on follow up. Diagnostics Coronary angiogram showed ostioproximal stenosis of the distal left main segment, the proximal left anterior descending artery and the proximal left circumflex artery, with the right coronary artery being totally occluded. Two dimensional echocardiogram showed an ejection fraction of 38 percent with multisegmental wall motion abnormalities. CT aortogram showed segmental narrowing of the infrarenal abdominal aorta with multiple ostioproximal stenosis of several aortic branches with extensive collateral formation. MRI showed acute infarction in the right thalamus,right medial temporal and occipital lobes and right cerebellar hemisphere and vermis Conclusion Takayasu’s arteritis can present with a myriad of vascular complications. The reported incidence of coronary involvement is low. This case highlights the progressive and unpredictable nature of this disease. A high index of clinical suspicion, as well as a meticulous search for the extent of disease severity allows the clinician to individualize treatment options for these patients.

Background: Takayasu's arteritis is a chronic vasculitis of unknown etiology affecting large vessels. Coronary involvement is rare and myocardial infarction as a presenting symptom has only been described in case reports. Case: We report a case of a 19 year old female diagnosed with Takayasu's arteritis 2 years prior who came in due to chest pain and heart failure symptoms. ECG showed diffuse ischemia with ST elevation of the inferior wall. Coronary angiogram showed 3 vessel disease with left main involvement. Patient was started on high dose steroids. She then developed an acute stroke in the right posterior cerebral artery territory. She improved with Methylprednisolone pulse therapy and oral methotrexate. She was discharged on Prednisone, Methotrexate and cardiac medications and is stable on follow up. Diagnostics: Coronary angiogram showed ostioproximal stenosis of the distal left main segment, the proximal left anterior descending artery and the proximal left circumflex artery, with the right coronary artery being totally occluded. Two dimensional echocardiogram showed an ejection fraction of 38 percent with multisegmental wall motion abnormalities. CT aortogram showed segmental narrowing of the infrarenal abdominal aorta with multiple ostioproximal stenosis of several aortic branches with extensive collateral formation. MRI showed acute infarction in the right thalamus,right medial temporal and occipital lobes and right cerebellar hemisphere and vermis Conclusion: Takayasu's arteritis can present with a myriad of vascular complications. The reported incidence of coronary involvement is low. This case highlights the progressive and unpredictable nature of this disease. A high index of clinical suspicion, as well as a meticulous search for the extent of disease severity allows the clinician to individualize treatment options for these patients.

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Background: Chronic mitral regurgitation can be divided into primary and secondary. The most common cause of chronic primary mitral regurgitation in developed countries is mitral valve prolapse. Many patients remain asymptomatic for quite some time, although its presence has an impact on the prognosis that is why it is mandatory to be address appropriately. In patients with chronic symptomatic, severe mitral regurgitation from degenerative cause, surgical mitral valve repair remains the gold standard. However, percutaneous mitral valve repair has been in progress in different countries and it has shown propitious result. Mitraclip restores leaflet coaptation by approximating the edges of the regurgitant mitral valve leaflets under transesophageal echocardiography and fluoroscopic guidance.