Coronary Artery Bypass Grafting in a Patient With Polyarteritis Nodosa

Area of Science:

• Cardiovascular Medicine
• Rheumatology
• Vascular Biology

Background:

• Polyarteritis nodosa (PAN) is a systemic vasculitis.
• Coronary artery involvement in PAN is rare but serious.
• Exertional chest pain can indicate underlying coronary artery disease.

Observation:

• A 38-year-old male patient with diagnosed polyarteritis nodosa presented with exertional chest pain.
• Coronary angiography identified significant three-vessel coronary artery disease.
• The left internal thoracic artery was deemed unsuitable for bypass grafting due to its poor condition.

Findings:

• Coronary artery bypass grafting was performed using a saphenous vein graft for two coronary vessels.
• Histopathological analysis of the excised left internal thoracic artery revealed significant pathological changes consistent with polyarteritis nodosa.
• This finding directly links the patient's vasculitis to the compromised state of the coronary artery.

Implications:

• This case underscores the potential for polyarteritis nodosa to directly impact coronary arteries, necessitating thorough cardiovascular assessment in affected individuals.
• Understanding the vascular effects of PAN is crucial for guiding treatment strategies and improving patient outcomes.
• Early recognition and management of coronary involvement in polyarteritis nodosa can prevent severe cardiac events.