Manole Oana-Mădălina, Haba Mihai Ștefan Cristian, Matei Iulian-Theodor, Onofrei Viviana
Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
Department of Cardiology, "St. Spiridon" County Clinical Emergency Hospital, 700111 Iași, Romania.
Diagnostics (Basel). 2024 Nov 22;14(23):2623. doi: 10.3390/diagnostics14232623.
Antineutrophil cytoplasm antibody (ANCA)-associated vasculitis usually affects small blood vessels and is characterized by the presence of circulating autoantibodies (c-ANCA or p-ANCA). The risk of cardiovascular events is threefold higher compared to general population, and cardiac manifestations include myocarditis, pericarditis, valvulitis, aortitis, or coronary arteritis. Coronary involvement is very rare, but it is a potentially life-threatening manifestation.
We present an atypical cardiac scenario of p-ANCA vasculitis.
A 68-year-old woman with known p-ANCA vasculitis and stage 5 chronic kidney disease (CKD) on hemodialysis presented with dizziness accompanied by low blood pressure and chest pain. Electrocardiogram on arrival showed slightly ST-T changes, with negative cardiac biomarkers and no abnormalities in cardiac regional wall motion. Five hours after presentation, the patient repeated chest pain, accompanied by a drop in blood pressure and junctional escape rhythm. The highly sensitive cardiac troponin I (hs-cTnI) was raised at 560 ng/L. Coronary angiography showed coronary arteries without significant stenosis. The provocative test with intracoronary ergonovine demonstrated coronary vasospasm of the anterior descending artery accompanied by chest pain, with resolution after intracoronary nitroglycerin. Under amlodipine, nitrate, acetylsalicylic acid, statin and corticosteroids the patient did not experience the recurrence of angina.
This case illustrates coronary involvement, manifested as coronary spasm with favorable outcomes, in systemic vasculitis. The underlying mechanism is immune-mediated inflammation in vascular walls.
抗中性粒细胞胞浆抗体（ANCA）相关血管炎通常累及小血管，其特征为循环自身抗体（c-ANCA或p-ANCA）的存在。与普通人群相比，心血管事件风险高出三倍，心脏表现包括心肌炎、心包炎、瓣膜炎、主动脉炎或冠状动脉炎。冠状动脉受累非常罕见，但却是一种潜在的危及生命的表现。
我们呈现了一例p-ANCA血管炎的非典型心脏病例。
一名68岁女性，已知患有p-ANCA血管炎且处于血液透析的5期慢性肾脏病（CKD），出现头晕伴低血压和胸痛。入院时心电图显示ST-T轻度改变，心脏生物标志物阴性，心脏局部壁运动无异常。就诊5小时后，患者再次出现胸痛，伴有血压下降和交界性逸搏心律。高敏心肌肌钙蛋白I（hs-cTnI）升高至560 ng/L。冠状动脉造影显示冠状动脉无明显狭窄。冠状动脉内麦角新碱激发试验显示前降支冠状动脉痉挛伴胸痛，冠状动脉内硝酸甘油治疗后缓解。在氨氯地平、硝酸盐、阿司匹林、他汀类药物和糖皮质激素治疗下，患者未再发生心绞痛。
该病例说明了在系统性血管炎中冠状动脉受累表现为冠状动脉痉挛且预后良好。其潜在机制是血管壁的免疫介导炎症。
