Smiyan Svitlana, Komorovsky Roman, Tomashchuk Nazarij
2 Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Ukraine.
Department of Cardiac Surgery, Lviv Regional Hospital, Ukraine.
Reumatologia. 2019;57(4):243-248. doi: 10.5114/reum.2019.87621. Epub 2019 Aug 31.
Although patients with rheumatoid arthritis (RA) may have an increased incidence of cardiovascular events, the development of coronary artery disease and of myocardial infarction at young age is rather uncommon. Herein, we report a case of a 26-year-old man without classical cardiovascular risk factors, but with a 2-year history of RA, who experienced recurrent episodes of angina-like chest pain. His electrocardiogram showed ST-elevation and T-wave inversion in anterior chest leads, and the patient was sent for coronary angiography, which revealed multivessel coronary artery disease. Subsequently, the patient underwent coronary artery bypass grafting. Closer analysis of the patient's history and of the laboratory findings led to revision of the diagnosis of RA: the patient was found to meet the classification criteria for systemic lupus erythematosus. Pitfalls of the classification criteria and the impact of the revised diagnosis on the patient's care are discussed.
虽然类风湿关节炎（RA）患者心血管事件的发生率可能会增加，但年轻时发生冠状动脉疾病和心肌梗死的情况相当少见。在此，我们报告一例26岁男性患者，他没有典型的心血管危险因素，但有2年的RA病史，曾反复出现心绞痛样胸痛。他的心电图显示前胸导联ST段抬高和T波倒置，该患者被送去做冠状动脉造影，结果显示有多支冠状动脉病变。随后，该患者接受了冠状动脉搭桥手术。对患者病史和实验室检查结果进行更深入分析后，对RA的诊断进行了修正：发现该患者符合系统性红斑狼疮的分类标准。本文讨论了分类标准的缺陷以及修正诊断对患者治疗的影响。
