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Chest Pain: The Need to Consider Less Frequent Diagnosis

Published on Jan 1, 2016in Case reports in cardiology
· DOI :10.1155/2016/4294780
Pedro Jorge Caldas Magalhães23
Estimated H-index: 23
,
Anabela Morais + 4 AuthorsTrigo Faria
Abstract
Chest pain is one of the most frequent patient's complaints. The commonest underlying causes are well known, but, sometimes, in some clinical scenarios, it is necessary to consider other diagnoses. We report a case of a 68-year-old Caucasian male, chronically hypertensive, who complained of recurrent episodes of chest pain and fever with elevated acute phase reactants. The first investigation was negative for some of the most likely diagnosis and he quickly improved with anti-inflammatory drugs. Over a few months, his symptoms continued to recur periodically, his hypertension was aggravated, and he developed headaches and lower limbs claudication. After a temporal artery biopsy that was negative for vasculitis, he underwent a positron emission tomography suggestive of Takayasu Arteritis. Takayasu Arteritis is a rare chronic granulomatous vasculitis of the aorta and its first-order branches affecting mostly females up to 50 years old. Chest pain is experienced by >40% of the patients and results from the inflammation of the aorta, pulmonary artery, or coronaries.
  • References (10)
  • Citations (0)
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References10
Newest
#1Soumya Chatterjee (Cleveland Clinic)H-Index: 13
#2Scott D. Flamm (Cleveland Clinic)H-Index: 52
Last. E. Rene Rodriguez (Cleveland Clinic)H-Index: 40
view all 4 authors...
Large vessel vasculitis (LVV) covers a spectrum of primary vasculitides predominantly affecting the aorta and its major branches. The two main subtypes are giant cell arteritis (GCA) and Takayasu arteritis (TA). Less commonly LVV occurs in various other diseases. Clinical manifestations result from vascular stenosis, occlusion, and dilation, sometimes complicated by aneurysm rupture or dissection. Occasionally LVV is discovered unexpectedly on pathological examination of a resected aortic aneury...
14 CitationsSource
#1Soumya Chatterjee (Cleveland Clinic)H-Index: 13
#2Scott D. Flamm (Cleveland Clinic)H-Index: 52
Last. E. Rene Rodriguez (Cleveland Clinic)H-Index: 40
view all 4 authors...
Takayasu arteritis (TA) is 1 of the 2 main causes of large vessel vasculitides (LVV), giant cell arteritis being the other. LVV can also develop in various other systemic diseases. In TA, a wide variety of symptoms result from vascular stenoses, occlusions, and dilation. Aneurysms may develop and may occasionally dissect or rupture. Disease activity can sometimes be difficult to assess clinically. Diagnostic modalities also have their shortcomings. Often, acute phase reactants do not accurately ...
23 CitationsSource
#1Gokhan Keser (Marmara University)H-Index: 26
#2Haner Direskeneli (Marmara University)H-Index: 39
Last. Kenan Aksu (Marmara University)H-Index: 26
view all 3 authors...
Assessment of the pattern and extent of arterial involvement and measurement of current disease activity are essential for the management of Takayasu arteritis (TA). Since there is no completed, placebocontrolled, randomized clinical trial, the level of evidence for management of TA is low, generally reflecting the results of open studies, case series and expert opinion. The most commonly used agents include corticosteroids and conventional immunosuppressive agents such as MTX, AZA, MMF and LEF....
88 CitationsSource
#1Jean Schmidt (French Institute of Health and Medical Research)H-Index: 7
#2Tanaz A. Kermani (UCLA: University of California, Los Angeles)H-Index: 18
Last. Kenneth J. Warrington (Mayo Clinic)H-Index: 33
view all 7 authors...
Abstract Objective To describe the clinical features, treatment, and outcomes in a longitudinal cohort of patients with Takayasu arteritis (TAK). Patients and Methods We retrospectively studied patients with newly diagnosed TAK evaluated from January 1, 1984, through December 31, 2009. Results The cohort included 126 patients who were predominantly white (85/103; 82.5%) and female (115/126; 91%). The median age at diagnosis was 31.6 years (interquartile range, 22.9-39.8 years). Median delay in d...
76 CitationsSource
#1Marc S. SabatineH-Index: 90
#2Christopher P. CannonH-Index: 134
21 CitationsSource
#2Brian F. MandellH-Index: 20
22 CitationsSource
#1Jens Eichhorn (Humboldt University of Berlin)H-Index: 5
#2Dagmar Sima (Humboldt University of Berlin)H-Index: 4
Last. Friedrich C. Luft (Humboldt University of Berlin)H-Index: 110
view all 9 authors...
Background Although a specific etiology for Takayasu arteritis has not been found, the bulk of evidence favors an autoimmune mechanism. We examined the sera of 19 patients with Takayasu arteritis for antineutrophil cytoplasmic antibodies (ANCA), antinuclear antibodies (ANA), anti-DNA antibodies, antibodies to extractable nuclear antigens (ENA), anti-Ro antibodies, anticardiolipin antibodies, circulating immune complexes, and anti–endothelial cell antibodies (AECA). Methods and Results We used en...
82 CitationsSource
#1Beat A. MichelH-Index: 16
#2William P. ArendH-Index: 58
Last. Gene G. HunderH-Index: 77
view all 3 authors...
Objective. To determine whether giant cell (temporal) arteritis (GCA) can be differentiated from Takayasu's arteritis on the basis of clinical findings. Methods. A comparative study contrasting 217 patients with GCA to 63 patients with Takayasu's arteritis was conducted, using the prospectively gathered large multicenter data set of the American College of Rheumatology Vasculitis Criteria Databank. Logistic regression and recursive partitioning were used to assess the capability of a variety of ...
54 Citations
#1A. Rodríguez-pla (Autonomous University of Barcelona)H-Index: 2
#2G. de Miguel (Autonomous University of Barcelona)H-Index: 2
Last. C. Díaz (Autonomous University of Barcelona)H-Index: 2
view all 6 authors...
We report the case of a 61-year-old woman who presented bilateral blindness at the age of nineteen. Although she did not receive any treatment, she did not present any other symptoms through 40 years of follow-up. After reviewing the literature, we have not found any case of bilateral blindness as the first manifestation of TD without further progression of the disease despite the absence of treatment.
4 CitationsSource
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