Acute myocardial infarction as the first manifestation of Takayasu arteritis

Abstract

Rationale: Takayasu arteritis (TA) is a chronic inflammatory disease involving the aorta and its major branches. Initial diagnosis is usually difficult due to the highly variable symptoms. Acute myocardial infarction (AMI) is a very rare presentation in patients with TA. Moreover, the choice of early management for these patients is not well established. Patient concerns: A 34-year-old woman was taken to the Emergency Department of our hospital, presenting with a sudden onset and persistent retrosternal chest pain radiating to both upper extremities for 2 hours. Blood pressures were different between 2 arms with 151/115 mm Hg on the right arm and 140/100 mm Hg on the left arm. Diagnoses: The patient was diagnosed with TA according to the medical history, physical examination, and vascular imaging. Interventions: Primary percutaneous coronary intervention (PPCI) was performed to restore the coronary flow of left anterior descending. Meanwhile, combination of oral glucocorticoids and immunosuppressive agents was administered to halt disease progression of TA. Outcomes: Chest pain was relieved without rest and exertional angina. The patient achieved long-term remission without symptom relapse during our follow-up. Lessons: Percutaneous coronary intervention was essential and effective in AMI of TA. Timely immunosuppressive therapy could improve the long-term outcome.

A Rare Presentation of Type-III Takayasu’s Arteritis in a 20-Year-Old Female

“…Takayasu’s arteritis may result in non-specific symptoms of upper body pain, intermittent claudication, headache, dizziness, syncope, and visual deterioration [ 6 ]. Involvement of aortic branches can result in malaise, headache, decreased to absent pulses of upper extremities, dysfunction of upper extremities, dizziness, visual disturbances, and syncope [ 4 ].…”

“…As the initial symptoms are non-specific, diagnosis is frequently delayed, often resulting in complications later in the course of diagnosis. One study reported a patient presenting with acute myocardial ischemia [ 6 ]. Our patient was diagnosed as a case of Takayasu’s arteritis based upon criterion proposed by the American college of rheumatology, of which our patient had four i.e.…”

Three‐year outcome with drug‐coated balloon percutaneous coronary intervention in coronary Takayasu arteritis: A case review

“…Table 1 lists the seven case reports of DES PCI in coronary TA. Cases 1, 3, 5, and 7 have reported PCI with DES with variable durations of follow‐up ranging from 12 weeks to 4 years 6,11‐13 . Yokota et al (case 5) described a case of a 52‐year‐old woman who was followed up over 4 years and required a total of four PCIs due to recurrent in‐stent restenoses 6 .…”

Physical Exercise in Managing Takayasu Arteritis Patients Complicated With Cardiovascular Diseases

“…Therefore, for the young female patients with AMI, systemic disease such as TA should be taken into consideration. Several cases, primarily consisting of young women, have been reported to present AMI as the primary manifestation of TA ( 30 – 35 ). In a 5-year follow-up study, 9% (7/76) TA patients were detected to have AMI through echocardiography ( 4 ).…”

“…Prompt and early treatment is essential to the TA patients with AMI. Thus, the medical team should take percutaneous coronary interventions as prioritizing and timely immunosuppressive therapy could improve the cardiac status and long-term outcome ( 30 , 36 ).…”