Myocardial infarction in a young woman with isolated coronary arteritis
Chest
|September 1, 1982
Insights
A young woman experienced a heart attack and coronary artery aneurysms due to periarteritis nodosa. Prompt steroid therapy was initiated for this rare vasculitis presentation.
Area of Science:
- Cardiology
- Rheumatology
- Vascular Medicine
Background:
- Periarteritis nodosa (PAN) is a rare systemic vasculitis affecting medium-sized arteries.
- Cardiac involvement in PAN, particularly myocardial infarction, is uncommon.
- This case highlights an unusual presentation of PAN in a young adult.
Observation:
- A 26-year-old woman presented with fever, progressing to inferior myocardial infarction (heart attack).
- Diagnostic workup revealed elevated creatine kinase-MB (CPK-MB) and electrocardiogram (ECG) changes.
- Coronary angiography identified multiple coronary artery aneurysms.
Findings:
- Left ventriculography showed inferior wall hypokinesis, indicative of heart muscle damage.
- Visceral angiography excluded significant involvement of other organs.
- The clinical presentation and angiographic findings were most consistent with periarteritis nodosa.
Implications:
- This case underscores the importance of considering rare vasculitides like PAN in young patients presenting with myocardial infarction and coronary abnormalities.
- Early diagnosis and treatment with corticosteroids are crucial for managing PAN and preventing further cardiovascular complications.
- Further research into the cardiac manifestations of PAN may improve diagnostic and therapeutic strategies.
Abstract:
A 26-year-old black woman presented with a febrile illness and subsequently sustained an inferior myocardial infarction with chest pain. CPK-MB elevation and ECG changes. Left ventriculography revealed inferior wall hypokinesis, and coronary angiography demonstrated multiple aneurysms of the coronary arteries. Findings on visceral angiography of multiple organs was normal. Various etiologies were considered; however, her clinical course was felt to be most consistent with periarteritis nodosa and steroid therapy was instituted.
Related Concept Videos
01:21Myocarditis I: Introduction
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
01:27Myocarditis II: Clinical Features and Diagnostic Tests
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
01:14Myocarditis III: Medical Management
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
01:30Coronary Artery Disease III: Clinical Manifestations
Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...
01:30Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...