Original Paper

GSTF Journal of Advances in Medical Research (JAMR)

, 1:20

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Three Vessel Disease with Left Main Involvement: A Rare Manifestation of Takayasu’s Arteritis

  • Lucky R. CuenzaAffiliated withUniversity of Santo Tomas
  • , Jose Melanio GraydaAffiliated withUniversity of Santo Tomas Faculty of Medicine
  • , Therese Eileen L. NatividadAffiliated withUniversity of the East Ramon Magsaysay Center College of Medicine
  • , Francis Carl CatalanAffiliated withRemedios Trinidad Romualdez Medical FoundationCardinal Santos Medical Center in the Philippines
  • , Tamara Louise J. RazonAffiliated withUniversity of Santo TomasMakati Medical Center

Abstract

Background

Takayasu’s arteritis is a chronic vasculitis of unknown etiology affecting large vessels. Coronary involvement is rare and myocardial infarction as a presenting symptom has only been described in case reports.

Case

We report a case of a 19 year old female diagnosed with Takayasu’s arteritis 2 years prior who came in due to chest pain and heart failure symptoms. ECG showed diffuse ischemia with ST elevation of the inferior wall. Coronary angiogram showed 3 vessel disease with left main involvement. Patient was started on high dose steroids. She then developed an acute stroke in the right posterior cerebral artery territory. She improved with Methylprednisolone pulse therapy and oral methotrexate. She was discharged on Prednisone, Methotrexate and cardiac medications and is stable on follow up.

Diagnostics

Coronary angiogram showed ostioproximal stenosis of the distal left main segment, the proximal left anterior descending artery and the proximal left circumflex artery, with the right coronary artery being totally occluded. Two dimensional echocardiogram showed an ejection fraction of 38 percent with multisegmental wall motion abnormalities. CT aortogram showed segmental narrowing of the infrarenal abdominal aorta with multiple ostioproximal stenosis of several aortic branches with extensive collateral formation. MRI showed acute infarction in the right thalamus,right medial temporal and occipital lobes and right cerebellar hemisphere and vermis

Conclusion

Takayasu’s arteritis can present with a myriad of vascular complications. The reported incidence of coronary involvement is low. This case highlights the progressive and unpredictable nature of this disease. A high index of clinical suspicion, as well as a meticulous search for the extent of disease severity allows the clinician to individualize treatment options for these patients.

Key words

Takayasu’s arteritis myocardial infarction stroke