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[Myocardial infarction simultaneous with Buerger disease (obliterating thromboangiitis). A case report]
Jairo Rodríguez-Fernández1, Alberto Rangel, Eduardo Chávez
1Servicio de Hemodinamia, Hospital de Especialidades, CMN, LA Raza, IMSS, México, DF, México.
Insights
Buerger's disease rarely co-occurs with coronary artery disease. Angiography suggests thromboangiitis may spread to the coronary arteries, causing obstruction in rare cases.
Area of Science:
- Cardiology
- Vascular Medicine
- Rheumatology
Background:
- Buerger's disease, a rare inflammatory condition affecting blood vessels, typically involves the extremities.
- Co-occurrence with visceral disorders, particularly cardiac disease involving coronary obstruction, is infrequently reported.
- This case highlights a rare instance of Buerger's disease associated with ischemic heart disease.
Observation:
- A 56-year-old male, a long-term heavy smoker with a 15-year history of Buerger's disease, presented with symptoms of ischemic heart disease.
- Coronary angiography revealed an extensive anterior myocardial infarction, thrombosis, and severe (80%) obstruction of the left anterior descending coronary artery.
- The affected coronary artery exhibited a gracile, corkscrew-like appearance with intraluminal thrombi, characteristic of thromboangiitis.
Findings:
- The concurrence of Buerger's disease and coronary pathology is exceptionally rare.
- While coronariography alone cannot definitively prove a causal link, the characteristic angiographic findings suggest a potential dissemination of the vasculopathy to the coronary arteries.
- Immunological and histopathological tests are typically required for a definitive diagnosis of shared etiology.
Implications:
- This case underscores the possibility of Buerger's disease affecting coronary circulation, leading to myocardial infarction.
- Further research is needed to elucidate the mechanisms and prevalence of coronary involvement in Buerger's disease.
- Recognition of this rare association is crucial for timely diagnosis and management of cardiac complications in Buerger's patients.
Background:
Few cases of Buerger's disease concurring with visceral disorders, i.e., cardiac disease characterized by coronary obstruction have been published. We report the case of a 56 years old patient, with Buerger's disease concurring with ischemic heart disease: extensive anterior myocardial infarction, thrombosis, and obstruction of the left anterior descending coronary artery, evidenced through coronariography.
Description Of The Case:
Male patient, 56 years old, severe smoker since the age of 15, obese, normal blood pressure, carrier of Buerger's disease for 15 years, without symptoms or signs of rheumatic disorders, and negative immunological tests, with antecedents of an old extensive myocardial infarction secondary to diffuse disease of the left anterior descending artery. At present, with symptoms and signs of ischemic cardiopathy and angiographic images suggesting the presence of thrombi inside the anterior descending coronary artery, of gracile aspect (corkscrew image), severe and diffusely obstructed (80%), and poor distal vascular bed.
Discussion:
Causal association between Buerger's disease and coronary disease is rare and difficult to demonstrate in the absence of immunological and histopathological tests. Data provided by coronariography do not evidence a common origin for both diseases. However, the angiographic image of the gracile coronary artery, corkscrew-shaped, and with intraluminal thrombi suggests dissemination of the thromboangiitis to the coronary arterial bed.
Conclusion:
The concurrence of Buerger's disease with coronary pathology is rare. Coronary dissemination is difficult to demonstrate with only coronariography data; however, there are data in the medical literature suggesting that coronary obstruction, in these cases, results from the dissemination of the vasculopathy.