Giant Cell Arteritis Presenting With Myocardial Infarction

• Published in: Canadian journal of neurological sciences 2024-07, Vol.51 (4), p.588-589
• Main Authors: Handzic, Armin, Zaslavsky, Kirill, Margolin, Edward
• Format: Article
• Language: English
• Subjects: Atherosclerosis; Biopsy; Cardiovascular disease; Coronary vessels; Edema; Heart attacks; Inflammation; Ischemia; Letter to the Editor: New Observation; Medical imaging; Patients; Vein & artery diseases
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2023.262

[...]accelerated formation of atherosclerotic plaque due to chronic vessel wall inflammation with resultant endothelial changes is an alternative possibility. [...]indirect adverse effects from the disease itself such as exposure to long-term treatment with glucocorticoids can negatively affect patient’s cardiovascular condition and patients with GCA display cardiovascular risk factors more frequently than the age-matched general population.2 Thus, when coronary angiography reveals occluded coronary arteries in patients with GCA, it could be the result of either ruptured atherosclerotic plaque or vasculitis, with the autopsy being the only way to definitely establish underlying pathophysiology.1,2 While it is possible that in our patient occurrence of MI and GCA were unrelated, angiography performed only 4 months prior demonstrated nonobstructive disease with less than 50% stenosis in the worst occluded vessels; thus, we postulate that vasculitis caused by GCA has caused further decrease in the size of vascular lumen producing critical myocardial ischemia. Considering GCA as the cause of adverse cardiac events in all patients with the recent diagnosis of GCA is pivotal and might be life-saving as the incidence of MI and cerebral ischemia in treated GCA patients is low, confirming the role of treatment in lowering heart- and brain-related ischemic events due to vasculitis.4 In summary, our case reminds neurologists that in rare cases GCA can be associated with MI.