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PanVascular Medicine, Second Edition

Inflammatory Diseases of the Coronary Arteries

Publication ,  Chapter
Dye, JR; Kaul, MS; St. Clair, EW
January 1, 2015

Rarely, inflammatory disorders affect the coronary arteries, as well as the aorta and other large arteries. Giant cell arteritis (GCA), Takayasu’s arteritis (TA), polyarteritis nodosa (PAN), and Kawasaki’s disease (KD) are the major forms of systemic vasculitis that most often target these vessels. However, vasculitis is a much less common cause of coronary artery disease, aortic aneurysm, and large-artery stenosis than atherosclerosis, and the two are often difficult to distinguish from each other based on clinical and imaging findings alone. Vasculitic disorders are usually associated with signs and symptoms of multiorgan system involvement as well as laboratory findings of systemic inflammation, but it is not always the case. For example, a patient with GCA will often present with headache, scalp tenderness, transient visual obscuration, and fatigue and elevated serum levels of acute-phase reactants, while a minority may only present with aortic aneurysm and limb claudication without the typical clinical features. Patients with TA who develop pulseless disease will often have systemic complaints, but others may display only the signs and symptoms related to the involved arteries. Kawasaki’s disease evokes the appropriate suspicion of coronary artery vasculitis in children who present with the typical features of fever, mucocutaneous lesions, and cervical LN enlargement. Atypical clinical presentations, although uncommon, may be more of a diagnostic challenge. While the clinical presentation, laboratory findings, and the results of imaging studies may raise the possibility of systemic vasculitis, the gold standard for diagnosis is tissue histopathology. Therefore, a tissue diagnosis should be pursued if possible. However, tissue biopsy may not be feasible in some cases and the diagnosis reached from the clinical, laboratory, and imaging data alone. Depending on the nature of the disease, treatment usually consists of corticosteroids and other immunosuppressive agents and may include surgical intervention to manage the vascular complications.

Duke Scholars

DOI

ISBN

9783642370779

Publication Date

January 1, 2015

Start / End Page

1885 / 1916
 

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Dye, J. R., Kaul, M. S., & St. Clair, E. W. (2015). Inflammatory Diseases of the Coronary Arteries. In PanVascular Medicine, Second Edition (pp. 1885–1916). https://doi.org/10.1007/978-3-642-37078-6_64
Dye, J. R., M. S. Kaul, and E. W. St. Clair. “Inflammatory Diseases of the Coronary Arteries.” In PanVascular Medicine, Second Edition, 1885–1916, 2015. https://doi.org/10.1007/978-3-642-37078-6_64.
Dye JR, Kaul MS, St. Clair EW. Inflammatory Diseases of the Coronary Arteries. In: PanVascular Medicine, Second Edition. 2015. p. 1885–916.
Dye, J. R., et al. “Inflammatory Diseases of the Coronary Arteries.” PanVascular Medicine, Second Edition, 2015, pp. 1885–916. Scopus, doi:10.1007/978-3-642-37078-6_64.
Dye JR, Kaul MS, St. Clair EW. Inflammatory Diseases of the Coronary Arteries. PanVascular Medicine, Second Edition. 2015. p. 1885–1916.
Journal cover image

DOI

ISBN

9783642370779

Publication Date

January 1, 2015

Start / End Page

1885 / 1916