Rao Sarita, Rao Roshan, Kumar Achukatla, Benjamin Nitika, Pandey Akshat
Department of Cardiology, Apollo Hospitals Indore, Madhya Pradesh, 452010, India.
Department of Radiology, Apollo Hospitals Indore, Madhya Pradesh, 452010, India.
Eur Heart J Case Rep. 2024 Sep 18;8(10):ytae487. doi: 10.1093/ehjcr/ytae487. eCollection 2024 Oct.
Severe hypertension in young patients presents a significant diagnostic dilemma, and treatment can often be codified. Therefore, it is crucial to diagnose these cases for probable secondary hypertension. Common causes of secondary hypertension include large vessel vasculitis, renal artery stenosis, coarctation of the aorta, and endocrine disorders.
A 23-year-old Asian male, who was previously in good health, presented with symptoms of chest pain, shortness of breath on exertion grade II, and generalized weakness. On examination, his blood pressure was markedly elevated at 200/110 mmHg. Diagnostic investigations revealed significant vascular involvement, including bilateral renal artery stenosis accompanied by aneurysm formation, celiac trunk disease, and osteal stenosis of the superior mesenteric artery. The patient underwent successful interventional procedure, including renal angioplasty, stenting, and aneurysm coiling. This was followed by tailoring of medical management along with anti-inflammatory and disease-modifying drugs.
The diagnosis of Takayasu arteritis (TAK) in this case is supported by the patients' age, presentation, and imaging according to the new TAK classification criteria by the American College of Rheumatology/European League Against Rheumatism (EULAR) and emphasizes the potential benefits of a pharmaco-invasive approach for optimal outcomes.
年轻患者的重度高血压带来了重大的诊断难题，治疗方案往往可以规范化。因此，诊断这些可能为继发性高血压的病例至关重要。继发性高血压的常见病因包括大血管血管炎、肾动脉狭窄、主动脉缩窄和内分泌紊乱。
一名23岁的亚洲男性，既往身体健康，出现胸痛、运动性二级呼吸困难和全身乏力症状。检查发现其血压显著升高，达200/110 mmHg。诊断性检查显示有明显的血管受累，包括双侧肾动脉狭窄伴动脉瘤形成、腹腔干疾病和肠系膜上动脉骨化狭窄。患者接受了成功的介入治疗，包括肾血管成形术、支架置入术和动脉瘤弹簧圈栓塞术。随后调整了药物治疗方案，并使用了抗炎和改善病情的药物。
根据美国风湿病学会/欧洲抗风湿病联盟（EULAR）新的大动脉炎（TAK）分类标准，该病例中TAK的诊断得到了患者年龄、临床表现和影像学检查结果的支持，并强调了药物介入方法对于实现最佳治疗效果的潜在益处。
