Isolated coronary ostial stenosis associated with coronary vasospasm

Area of Science:

• Cardiology
• Vascular Medicine
• Endocrinology

Background:

• Takayasu's arteritis is a rare, chronic inflammatory disease affecting large arteries, primarily the aorta and its branches.
• Coronary artery involvement in Takayasu's arteritis can lead to myocardial ischemia and infarction, often presenting with symptoms mimicking atherosclerosis.
• Hyperthyroidism is an endocrine disorder that can rarely be associated with vascular inflammation and stenosis.

Observation:

• A 50-year-old woman presented with preshock, found to have severe left coronary ostial stenosis (90%) on angiography.
• The patient was diagnosed with hyperthyroidism, which was treated with methimazole over 2 months.
• Follow-up angiography revealed significant improvement in left coronary stenosis (50%) and aortography showed signs consistent with Takayasu's arteritis.

Findings:

• Treatment of hyperthyroidism resulted in marked improvement of the left coronary artery stenosis.
• The patient's vascular abnormalities were ultimately attributed to Takayasu's arteritis, evidenced by subclavian artery occlusion and aortic irregularities.
• This case demonstrates a potential link between hyperthyroidism and the exacerbation or manifestation of large vessel vasculitis.

Implications:

• Hyperthyroidism should be considered in the differential diagnosis of patients presenting with unexplained coronary or large artery stenosis.
• Effective management of hyperthyroidism may lead to regression of vascular inflammation and stenosis in certain vasculitic conditions.
• This case underscores the importance of a comprehensive diagnostic approach in complex cardiovascular presentations, integrating endocrinological and rheumatological evaluations.