Heart Care Info - Heart Disease Prevention & Treatment

Coronary Angiitis and Cardiac Arrest in Antineutrophil Cytoplasmic-Antibody Associated Systemic Vasculitis

ASV Shah, JN Din, JR Payne, N Dhaun... - Circulation, 2011 - Am Heart Assoc1. From the Centre for Cardiovascular Science, Edinburgh University (ASVS, MAD, NLM); Edinburgh Heart Centre, Royal Infirmary of Edinburgh (JND, JRP); and the Department of Renal Medicine, Royal Infirmary of Edinburgh (ND), UK.

A 58-year-old man was admitted with a 6-week history of fever, lethargy, arthralgia, and dyspnea on exertion. He had no prior illness or cardiovascular risk factors, and with the exception of a pyrexia, his physical examination was unremarkable. Investigations were performed, including blood and urine cultures and a connective tissue screen. He was subsequently discharged with a view to an early outpatient review when he collapsed at home with cardiac arrest.

The initial rhythm was ventricular fibrillation, which was successfully cardioverted. His postarrest electrocardiogram revealed transient right bundle-branch block and his plasma troponin I concentration was raised at 8.5 μg/L. His renal function was normal, but markers of inflammation were raised, with a C-reactive protein concentration of 134 mg/L and an erythrocyte sedimentation rate of 96 mm/h. His PR3-antineutrophil cytoplasmic antibody titer was strongly positive at 90 U/m L.

An echocardiogram revealed mild concentric left ventricular hypertrophy with normal left ventricular function and no regional wall motion abnormality. He underwent coronary angiography, which excluded obstructive atheromatous disease in the major epicardial vessels but identified pruning of the distal branch vessels, including the first and second marginals and the first diagonal branch, in keeping with a systemic vasculitic process (Figure 1; Movie I of the online-only Data Supplement). A gadolinium-contrast-enhanced cardiovascular magnetic resonance scan was performed (Figure 2); functional cines confirmed basal posterolateral hypokinesis, while late enhancement sequences following contrast demonstrated patchy hyperenhancement involving the subendocardium (25% to 75% transmurality) in all 3 coronary artery territories (Movie II of the online-only ...