Myopericarditis in giant cell arteritis: case report of diagnostic dilemma and review of literature

Abstract

Giant cell arteritis (GCA), also known as granulomatous arteritis is a systemic vasculitis mainly affecting extra cranial branches of carotid arteries. It can rarely affect other vascular beds causing thoracic aorta aneurysm, dissection and rarely cause myocardial infarction through coronary arteritis. It can cause considerable diagnostic dilemma due to varied clinical presentations. The authors report an illustrative case of a 70-year-old woman with GCA who developed symptoms suggestive of acute myocardial infarction with chest pain, localised ST-T changes and echocardiographic left ventricular dysfunction. However, cardiac troponin T biomarkers and coronary angiography were normal. Her symptoms subsided with steroid treatment. Cardiac symptoms at first presentation of GCA are unusual.

Figure 1

(A) ECGs on admission and changes over initial 5 days. (B) ECG 1 year later.

Figure 2

Sequential echocardiography – apical four chamber view (LV, left ventricle; LA, left atrium; RA, right atrium). (A) Three days later – lower septum and apical hypokinesia (AH), left ventricular ejection fraction of 40% and no significant pericardial effusion, (B) 6 weeks later – improvement in LV function and development of small pericardial effusion (PerE), (C) 7 weeks later – large pericardial effusion predominantly over right heart (arrows pointing to PerE), (D) 3 months later – no pericardial effusion.

Figure 3

Sequential echocardiography – subcostal view (LV, left ventricle, LA, left atrium, RA, right atrium). (A) Three days later – no significant pericardial effusion, (B) 6 weeks later – small pericardial effusion (PerE), (C) 7 weeks later – large pericardial effusion especially over right heart, (D) 3 months later – no pericardial effusion.

Figure 4

Coronary angiogram: normal coronary arteries and left ventricular (LV) function.