An unusual case of Takayasu arteritis presenting as acute myocardial infarction and ischaemic stroke
Takayasu arteritis as infarction and stroke
Keywords:Takayasu arteritis, Myocardial infarction, Ischaemia, Stenosis, Occlusion
INTRODUCTION: Takayasu’s arteritis (TA) is well-known yet rare disorder, defined as a chronic large vessel vasculitis mainly involving the aorta and its major branches. We present a complex case of a 51-year-old female patient who first presented with acute myocardial infarction as an initial manifestation of Takayasu arteritis, and later with an acute onset of ischemic stroke.
CASE REPORT: We present a case of 51-year-old female patient who was admitted at the Clinic of Nephrology and Clinical Immunology. During hospitalization, a sudden onset of intense chest pain occurred, followed by a development of heart failure to the level of cardiogenic shock. Electrocardiography showed signs of ST-elevated myocardial infarction (STEMI) of the anterior wall, and an increase in cardiospecific enzymes. CT angiography indicated an occlusion of the left ACC, subclavian and axillary arteries as well as a penetrating aortic ulcer localized infrarenal. In the further course of treatment, left-sided weakness of the body was registered. Head CT scan showed an acute ischemic lesion high parietal on the right, as well as a chronic ischemic lesion on the front right. Doppler ultrasonography of carotid and vertebral arteries registered left occlusion, right ACC / ACE stenosis with suspected "macaroni sign". Final diagnosis of Takayasu arteritis was established and corticosteroids were included in the therapy (primarily in pulse doses) with the first pulse of cyclophosphamide of 1000mg.
CONCLUSION: This disease should be considered in young female patients who present with chronic inflammation and acute coronary syndrome.
Salvo F. Takayasu arteritis in young women with acute ischemic heart disease: Time to shift from anecdote to clinical practice? Int J Cardiol. 2018;252:37–8.
Sun T, Zhang H, Ma W, Yang L, Jiang X, Wu H, et al. Coronary artery involvement in takayasu arteritis in 45 Chinese patients. J Rheumatol. 2013;40(4):493–7.
Eleftheriou D, Varnier G, Dolezalova P, McMahon AM, Al-Obaidi M, Brogan PA. Takayasu arteritis in childhood: retrospective experience from a tertiary referral centre in the United Kingdom. Arthritis Res Ther. 2015;17(1):36.
Sikaroodi H, Motamedi M, Kahnooji H, Gholamrezanezhad A, Yousefi N. Stroke as the first manifestation of Takayasu arteritis. Acta Neurol Belg. 2007;107(1):18-21.
Yokota K, Shimpo M, Iwata T, Hirose M, Ikemoto T, Ohya K, et al. A case of Takayasu arteritis with repeated coronary artery restenosis after drug-eluting stent implantation successfully treated with a combination of steroids. Intern Med. 2012;51(7):739-43.
Cavalli G, Tomelleri A, Di Napoli D, Baldissera E, Dagna L. Prevalence of Takayasu arteritis in young women with acute ischemic heart disease. Int J Cardiol. 2018;252:21-23.
Dogan S, Piskin O, Solmaz D, Akar S, Gulcu A, Yuksel F,et al. Markers of endothelial damage and repair in Takayasu arteritis: are they associated with disease activity? Rheumatol Int. 2014 Aug;34(8):1129-38.
Shibata N, Taniguchi T, Umemoto N, Shimizu K, Murohara T. Multimodality findings of coronary stenosis and aneurysm in Takayasu arteritis: a case report. Coron Artery Dis. 2019;30(7):551-552.
Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol. 1996;54 Suppl:S155-63.
Ishiyama Y, Eguchi K, Yokota K, Ikemoto T, Kario K. New-onset Takayasu's Arteritis as Acute Myocardial Infarction. Intern Med. 2018;57(10):1415-1420.
Soeiro Ade M, Almeida MC, Torres TA, Franken M, Lima FG, Ganem F, et al. Clinical characteristics and long-term outcome of patients with acute coronary syndromes and Takayasu arteritis. Rev Port Cardiol. 2013;32(4):297-302.
Soto ME, Espinola-Zavaleta N, Ramirez-Quito O, Reyes PA. Echocardiographic follow-up of patients with Takayasu's arteritis: five-year survival. Echocardiography. 2006;23(5):353-60.
Hlavaty L, Diaz F, Sung L. Takayasu Arteritis of the Coronary Arteries Presenting as Sudden Death in a White Teenager. Am J Forensic Med Pathol. 2015;36(3):221-3.
Yuan SM, Lin HZ. Coronary artery involvements in Takayasu arteritis: systematic review of reports. Gen Thorac Cardiovasc Surg. 2020;68(9):883-904.
Zhang T, Peng B, Tu X, Zhang S, Zhong S, Cao W. Acute myocardial infarction as the first manifestation of Takayasu arteritis: A case report. Medicine (Baltimore). 2019;98(15):e15143.
Couture P, Chazal T, Rosso C, Haroche J, Léger A, Hervier B, et al. Cerebrovascular events in Takayasu arteritis: a multicenter case-controlled study. J Neurol. 2018;265(4):757-763.
Monti L, Servillo R, Grazzini I, Khader L, Acampa M, Cerase A. Neuroimaging of Takayasu Arteritis in a Patient with Ulcerative Rectocolitis. J Stroke Cerebrovasc Dis. 2017;26(7):e129-e132.
Kumral E, Evyapan D, Aksu K, Keser G, Kabasakal Y, Balkir K. Microembolus detection in patients with Takayasu's arteritis. Stroke. 2002;33(3):712-6.
de Paula LE, Alverne AR, Shinjo SK. Clinical and vascular features of Takayasu arteritis at the time of ischemic stroke. Acta Reumatol Port. 2013;38(4):248-51.
Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69(5):798-806.
Guo J, Zhang G, Tang D, Zhang J. A case report of Takayasu arteritis with aortic dissection as initial presentation. Medicine (Baltimore). 2017;96(45):e8610.
Yang S, Dong K, Zheng S. Abdominal pain as the presenting symptom of Takayasu arteritis in an adolescent male: A case report. Medicine (Baltimore). 2018 Jun;97(26):e11326.
Wu X, Duan HY, Gu YQ, Chen B, Wang ZG, Zhang J. Surgical treatment of multivessel lesions in Takayasu's arteritis: report of a case. Surg Today. 2011;41(4):552-5.
Hellmich B, Agueda A, Monti S, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis Annals of the Rheumatic Diseases 2020;79:19-30
Diao YP, Liu CW, Song XJ, Chen YX, Guo LL, Lian LS, et al. Surgical treatment of multivessel lesions in Takayasu arteritis. Chin Med J (Engl). 2013;126(24):4804-5.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.