Background HIV-infected persons develop coronary artery disease (CAD) more commonly and earlier than uninfected persons; however, the role of non-invasive testing to stratify CAD risk in HIV is not well defined. Methods and results Patients were selected from a single-center electronic cohort of HIV-infected patients and uninfected controls matched 1:2 on age, sex, race, and type of cardiovascular testing performed. Patients with abnormal echocardiographic or nuclear stress testing who subsequently underwent coronary angiography were included. Logistic regressions were used to assess differences by HIV serostatus in two co-primary endpoints: (1) severe CAD (≥70% stenosis of at least one coronary artery) and (2) performance of percutaneous coronary intervention (PCI). HIV-infected patients (N = 189) were significantly more likely to undergo PCI following abnormal stress test when compared with uninfected persons (N = 319) after adjustment for demographics, CAD risk factors, previous coronary intervention, and stress test type (OR 1.85, 95% CI 1.12-3.04, P = 0.003). No associations between HIV serostatus and CAD were statistically significant, although there was a non-significant trend toward greater CAD for HIV-infected patients. Conclusions HIV-infected patients with abnormal cardiovascular stress testing who underwent subsequent coronary angiography did not have a significantly greater CAD burden than uninfected controls, but were significantly more likely to receive PCI.

A 40-year-old man with no known past medical history was admitted for severe depression. A 12-lead electrocardiogram was obtained before electroconvulsive therapy, which revealed STsegment elevations in V 2 to V 3 . The patient denied any symptoms. Physical examination was unremarkable. Cardiac biomarkers were not elevated. Coronary angiography demonstrated beading of the left anterior descending artery ( Fig. 1), suggestive of fibromuscular dysplasia (FMD).Fibromuscular dysplasia is an idiopathic, nonatherosclerotic, and noninflammatory vasculopathy affecting small-to medium-sized arteries (1). The renal arteries (60% to 80%) and cervicocranial arteries (20% to 30%) are most commonly involved. However, approximately one-quarter of patients have more than 1 site affected. Overall, FMD is a rare disease with an incidence of 1% and 0.5% of renal arteries and carotid arteries, respectively. Fibromuscular dysplasia is characterized by a fibrous or fibromuscular thickening of the vessel wall affecting, medial, intimal, and adventitial layers at varying degrees (2). Regardless of the type of FMD, the disease can cause dissection, rupture, or Figure 1. Fibromuscular Dysplasia of the Left Anterior Descending Coronary Artery Coronary angiography of the left arterior descending artery system showing beading in the middle and distal portions of the artery.

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This case report describes a diagnosis of aortic dissection after a patient presentation of chest tightness, light-headedness, and a tingling sensation in the left arm and neck.