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Infective coronary arteritis: a pathological analysis at autopsy
Pradeep Vaideeswar1, Ravinder Verma, Rajib Gupta
1Department of Pathology (Cardiovascular and Thoracic Division), Seth G. S. Medical College and K. E. M. Hospital, Mumbai 400 012, India. shreeprajai@yahoo.co.in
Insights
Infective coronary arteritis, a rare cause of death, involves inflammation and bacterial infection of heart arteries. This study details 10 autopsy cases, highlighting its distinct pathology and association with other cardiac conditions.
Area of Science:
- Cardiovascular Pathology
- Infectious Diseases
- Forensic Medicine
Background:
- Coronary artery disease (CAD) is a major global mortality cause, primarily due to atherosclerosis.
- Nonatherosclerotic causes of CAD are rare, with infective arteritis being a recognized but infrequent subtype.
- Infective coronary arteritis, often diagnosed post-mortem, presents a diagnostic challenge.
Observation:
- This study presents clinicopathologic necropsy data from 10 patients who died from infective coronary arteritis.
- The patient cohort included 6 males and 4 females, ranging from a 2-year-old child to adults aged 26-59.
- Associated conditions included infective endocarditis (6 cases), rheumatic heart disease (3 cases), suspected bacteremia/septicemia (2 cases), and pre-existing coronary atherosclerosis (2 cases).
Findings:
- Histopathology revealed acute obliterative inflammatory infiltrate with neutrophils and bacterial colonies in epicardial and intramural coronary arteries.
- This represents the largest reported series of infective coronary arteritis.
- The findings underscore the inflammatory and infectious nature of this rare condition.
Implications:
- Highlights the importance of considering infective causes in nonatherosclerotic coronary artery disease, especially in autopsy findings.
- Suggests potential links between infective endocarditis, bacteremia, and the development of infective coronary arteritis.
- Emphasizes the need for awareness among pathologists and clinicians regarding this rare but fatal condition.
Abstract:
Coronary artery disease, one of the leading causes of worldwide adult mortality, is most commonly atherosclerotic in pathogenesis. Nonatherosclerotic etiologies are quite rare. In the latter category, infective arteritis or infective vasculitis of the coronary arteries is a very rare but well-recognized subtype, usually discovered at autopsy. In this article, we present the clinicopathologic necropsy data of 10 patients in whom infective coronary arteritis was the leading cause of death. Among the 10 cases, the male/female ratio was 6:4, and with the exception of a 2-year-old female child, all the other patients were adults with an age range of 26 to 59 years. Of the 10 cases, 6 had infective endocarditis along with history of rheumatic heart disease in 3 patients, whereas 2 other patients had strong clinical suspicion of bacteremia or septicemia. The remaining 2 cases had preexisting coronary atherosclerosis with a history of stent placement in 1 of them. All our cases showed on histopathology acute obliterative inflammatory infiltrate consisting mainly of neutrophils along with bacterial colonies (in most of them) involving the epicardial and intramural coronary arteries. To the best of our knowledge, this is the largest series of infective coronary arteritis to be reported in the world.
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