Sudden Death from Spontaneous Coronary Artery Dissection due to Polyarteritis Nodosa

Abstract

Spontaneous coronary artery dissection (SCAD) is an emerging and rare cause of acute coronary syndrome and sudden cardiac death. While it was previously reported among young females with fibromuscular dysplasia, new literature indicates that this condition could occur in older populations. Polyarteritis nodosa (PAN) causes systemic necrotizing vasculitis which typically affects small to medium-sized muscular arteries and could affect the coronary arteries. A few case reports of PAN causing acute coronary artery disease have been reported in the literature. We report a case of a 62-year-old lady who presented with abdominal pain and died abruptly during her stay; she was found to have PAN-associated SCAD on autopsy.

Characteristics and Outcomes of Coronary Artery Involvement in Polyarteritis Nodosa

“…Coronary artery lesions are not common (7/64) in PAN [1], but they can lead to angina pectoris and myocardial infarction (MI). Spontaneous coronary artery dissection (SCAD) may occur in some severe cases, which can cause sudden cardiac death [2,3]. However, PAN is a very rare vasculitis with an annual incidence of 0-1.6 cases/million people, and a prevalence of approximately 31 cases per million people [4].…”

“…J o u r n a l P r e -p r o o fCoronary artery lesions in PAN includ stenosis or occlusion, ectasia, aneurysms and acute coronary dissection and rupture[2]. Premature atherosclerotic coronary disease, likely secondary to coronary arteritis, has also been reported[23].…”

Ab0497 renal Involvement in Anca-Associated Vasculitis: Do the Presence of Anca and Their Type Matter?

“…Background: Bechet's disease (BD) is a chronic multisystemic vasculitis. Although its exact etiopathology is unknown, both autoimmune imbalances associated with genetic and abnormal immune response of effector lymphocytes promoted by infectious factors are suggested 1 . The increase of effector T cells (Teffs) and the decrease of regulatory T cells (Tregs) are possibly the involving factors in the pathogenesis of BD 2 .…”

“…Immunoregulatory combination therapies could promote the proliferation and functional recovery of Tregs in patients with BD and might help to alleviate disease activity. References: [1]…”

“…ANCA-associates glomerulonephritis (ANCA-GN) class was established according to Berden et al classification. 1 We retrospectively assessed ANCA renal risk score (ARRS) at disease onset. 2 Twelve patients (22.6%) developed endstage renal disease (ESRD) after a median of 12 (6.5; 28) months.…”