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Case Reports
. 2019 Apr;98(15):e15143.
doi: 10.1097/MD.0000000000015143.

Acute myocardial infarction as the first manifestation of Takayasu arteritis: A case report

Ting Zhang  1   2 , Bo Peng  1 , Xiang Tu  3 , Shan Zhang  4 , Sen Zhong  5 , Wenzhai Cao  6
Affiliations
Case Reports

Acute myocardial infarction as the first manifestation of Takayasu arteritis: A case report

Ting Zhang et al. Medicine (Baltimore). 2019 Apr.

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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Emergency ECG. ECG demonstrated ST-segment elevation of V1–V5. ECG = electrocardiogram.
Figure 2
Figure 2
Preoperative CT image. Chest CT revealed pulmonary congestion. CT = computed tomography.
Figure 3
Figure 3
Images of acute coronary angiography. Coronary artery images showed total occlusion in the mid-left anterior descending (A) and mid-left circumflex (B) coronary arteries.
Figure 4
Figure 4
Coronary angiography after stent implantation in anterior descending branch. Coronary angiography revealed that the stent expanded well.
Figure 5
Figure 5
ECG after coronary intervention. ECG revealed decrease in ST segment elevation in the precordial leads and T wave inversion.
Figure 6
Figure 6
CTA of pulmonary artery. CTA revealed pulmonary artery of right lower lobe was not visualized. CTA = computed tomography angiography.
Figure 7
Figure 7
CTA of head and neck artery. CTA showed stenosis in the middle segment of left subclavian artery (LSCA) and mid-distal part of right common carotid artery (RCCA).
Figure 8
Figure 8
CTA of thoracoabdominal aorta. CTA showed stenosis in the thoracoabdominal aorta.
See this image and copyright information in PMC

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