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Query: UMLS:C0039483 (giant cell arteritis)
 3,204 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of giant cell arteritis involving the coronary arteries and causing thrombosis and myocardial infarction is described. IgM deposits in the affected arteries were demonstrated by an immunoperoxidase technique.
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PMID:Giant cell arteritis of coronary arteries causing myocardial infarction. 739 52

Giant cell arteritis (GCA) is closely identified with the temporal arteritis-polymyalgia rheumatica syndrome of the elderly. It is also a systemic disease that can cripple and kill. Up to 15% of patients with temporal arteritis may have angiographic evidence of extracranial GCA, and aortic insufficiency, ruptured aortic aneurysm, aortic dissection, stroke, or myocardial infarction may be the initial manifestation of systemic GCA. A review of 72 cases of aortic and extracranial GCA, all with histopathologic verification of the disease, revealed that 25% of patients with aortic and extracranial large-vessel GCA had asymptomatic temporal arteritis; the ascending aorta and aortic arch were most frequently involved (39%), followed by the subclavian and axillary arteries (26%), and the femoropopliteal arteries (18%). Nine patients (12.5%) underwent an upper or lower limb amputation. Of the 18 patients whose death was directly attributable to extracranial GCA the causes were ruptured aortic aneurysm (6), aortic dissection (6), stroke (3), and myocardial infarction (3). The findings of these 72 cases caution against attributing all aortic and large-vessel arterial disease in the elderly to atherosclerosis and emphasize that timely surgical intervention may be necessary for life-saving and limb-salvage in patients with aortic and extracranial GCA.
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PMID:Aortic and extracranial large vessel giant cell arteritis: a review of 72 cases with histopathologic documentation. 766 46

Myocardial relaxation at the diastolic phase was not evaluated by multi-gated myocardial SPECT, although myocardial contraction at the systolic phase was studied by percent wall thickening and Bull's eye methods. We make out a myocardial volume curve and report to evaluate the myocardial relaxation using multi-gated myocardial SPECT. The study population consisted of 3 normal human subjects (3 male, 32-37 years old), 10 idiopathic cardiomyopathy, 10 coronary artery disease and 1 hypertensive heart disease combined with aortic regurgitation. All cases were injected 555 MBq of 99mTc-tetrofosmin (Amersham Healthcare Corporation) intravenously at rest. A triple detector gamma-camera (GCA-9300A, Toshiba Medical, Japan) and a data processing computer (GMS-5500A, Toshiba Medical, Japan) were used in this study. A cardiac cycle (R-R interval) was divided by 16 frames (50-80 msec per 1 frame). Eight myocardial volume curves were calculated at the anterior wall, apex and inferior wall of the vertical long axis view and were calculated at the septal wall, apex and lateral wall of the horizontal long axis view, respectively. The patterns of the myocardial volume curves were classified into 5 patterns (Normal pattern (N), Delayed Contraction pattern (DC), Delayed Relaxation pattern (DR), Mixed pattern (M) and Normal pattern with Decreased amplitude (ND)). Myocardial uptake was evaluated visually of grading into severe hypertrophy (5), hypertrophy (4), normal (3), mild hypoperfusion (2), hypoperfusion (1) and perfusion defect (0). We compared patterns of the myocardial volume curves to myocardial uptake in the same segments. It was possible to detect myocardial edge of the total 16 frames with 50-60% threshold in the normal volunteer and in patients with hypertrophic cardiomyopathy and to make a myocardial volume curve. The region of the severe myocardial perfusion defect could be detected with 20% threshold in patients with old myocardial infarction. In comparison with myocardial volume curves and myocardial uptake, 74.6% in the N pattern had a normal uptake (3), 66.7% in the ND pattern had a normal uptake (3), 61.5% in the DC pattern had a hypoperfusion segment (0, 1 or fill-in to normal uptake), 44.4% in the DR pattern had a hypertrophic segment (4, 5 or fill-in to increased uptake). The pattern of myocardial volume curve indicates myocardial contractility and relaxation in each myocardial segment.
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PMID:[Assessment of myocardial contraction and relaxation with 99mTc-tetrofosmin multi-gated myocardial SPECT]. 786 45

It has been reported sporadically that several types of coronary arteritis can result in myocardial infarction. Recently, we treated a 27-year-old with acute anterior myocardial infarction. Primary directional coronary atherectomy was performed in order to recanalize the totally occluded coronary artery. The atherectomized tissue consisted of thrombi and intima infiltrated with inflammatory cells and multinucleated giant cells. Underlying diseases which can result in giant cell arteritis were excluded. This report documents that coronary arteritis can induce acute myocardial infarction, and that directional coronary atherectomy can be an effective tool in the diagnostic method for coronary arteritis.
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PMID:Acute myocardial infarction in a young adult due to solitary giant cell arteritis of the coronary artery diagnosed antemortemly by primary directional coronary atherectomy. 787 20

Giant cell arteritis is frequently an attendant complication of polymyalgia rheumatica. While involvement of other arterial beds is occasionally identified, this syndrome is most frequently recognized when symptomatic involvement of the temporal arteries occurs. We describe such a patient who despite initial treatment with high-dose intravenous and standard (5-day) orally administered corticosteroid therapy suffered a fatal myocardial infarction, which at autopsy was shown to be a consequence of granulomatous coronary arteritis. The literature is reviewed and the clinical implications of this case are discussed.
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PMID:Fatal myocardial infarction resulting from coronary arteritis in a patient with polymyalgia rheumatica and biopsy-proved temporal arteritis. A case report and review of the literature. 818 28

A 76-yr-old woman with widespread giant cell arteritis and polymyalgia rheumatica is described. The patient had an unusual simultaneous involvement of the cranial (temporal) arteries demonstrated by biopsy, and of large elastic arteries (aorta and its major branches), medium-sized and small muscular arteries, arterioles and vasa vasorum found at autopsy. Coronary arteritis was responsible for the fatal myocardial infarction.
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PMID:Disseminated giant cell arteritis. 824 20

The autopsy findings of a 74-year-old women who unexpectedly died are presented. She had suffered from polymyalgia but typical symptoms of temporal arteritis had been absent and tentative treatment with prednisone had not improved the polymyalgic pain. The autopsy revealed a generalized giant cell arteritis involving the left temporal artery, the left common carotid artery, the ascending aorta, a submucosal artery of the ileum and the left anterior descending branch of the coronary arteries. Histology showed typical granulomatous infiltrates including giant cells, followed by thrombotical occlusion of the coronary artery branch and subsequent myocardial infarction. Giant cell arteritis is a systemic vasculitis of aged subjects with predominant localisation in the cranial arteries, but occasional involvement of any type of visceral and peripheral arteries. Coronary involvement with sudden cardiac death is not a commen complication of giant cell arteritis but has occasionally been described in the literature.
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PMID:[Sudden cardiac death in giant cell arteritis]. 903 14

A 74-year-old woman underwent elective double valve replacement (aortic and mitral) for rheumatic valvular disease. She failed to wean from cardiopulmonary bypass due to marked left ventricular dysfunction. At autopsy, severe giant cell arteritis confined to the intramural coronary arteries was seen. Furthermore, there were multiple areas of recent microscopic myocardial infarction around the intramural coronary arteries. This report describes a rare case of giant cell arteritis confined to intramural coronary arteries which lead to inadequate myocardial protection at the time of surgery.
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PMID:Giant cell arteritis confined to intramural coronary arteries. Unforeseen hazards myocardial protection. 1238 76

Hypogonadism has traditionally been classified as either hypogonadotropic or hypergonadotropic based on serum gonadotropin levels. However, when hypothalamic suppression of GnRH secretion occurs, it can mask an underlying hypergonadotropic state. In this report we document the unusual case of a 61-yr-old man with androgen insensitivity and coincidental functional hypogonadotropic hypogonadism (HH). Although functional HH is not a well-recognized entity in the male, major stress has been reported to cause transient suppression of the hypothalamic-pituitary-gonadal axis in men. The patient in question was noted to have undervirilization, minimal pubertal development, hypogonadal testosterone, and low gonadotropin levels consistent with congenital HH during a hospital admission for myocardial infarction. However, the patient had also had surgery for hypospadias, a clinical feature not typically part of the phenotypic spectrum of congenital HH. We therefore hypothesized that the combination of acute stress and chronic glucocorticoid administration for temporal arteritis induced transient HH in a patient with a disorder of sexual differentiation in whom gonadotropin levels would have otherwise been elevated. Using clinical, molecular, and genetic studies, the patient was found to have partial androgen insensitivity syndrome (PAIS) caused by a novel mutation (Ser(740)Cys) in the ligand-binding domain of the androgen receptor. Subsequent studies of the patient confirmed the characteristic gonadotropin and sex steroid abnormalities of PAIS. We describe for the first time a patient with PAIS presenting with a reversible hypogonadotropic biochemical profile triggered by an acute illness and corticosteroid therapy. This case highlights the necessity for caution when interpreting gonadotropin levels during acute stress.
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PMID:Acute stress masking the biochemical phenotype of partial androgen insensitivity syndrome in a patient with a novel mutation in the androgen receptor. 1500 85

An 89-year-old woman was found dead lying in her bed. Autopsy demonstrated a pronounced thickening of all coronary arteries except for the first 2-4 cm. Death was due to a recent myocardial infarction. Microscopically, the coronary arteries showed a substantial concentric thickening of all three layers with 90% narrowing. There was a dense transmural inflammatory infiltration with lymphocytes, macrophages, and numerous multinucleated giant cells. The CD68 positive giant cells were mostly located at the media-intima border in the vicinity of fragmented fibers of the lamina elastica interna. The aorta and its major branches including the carotid arteries, however, were free of inflammation and thickening. The findings were characteristic for giant cell arteritis, the equivalent of temporal Horton arteritis, but isolated involvement of the coronary arteries is exceptional.
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PMID:Sudden death due to giant cell coronary arteritis. 1664 50


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