Gunsaulus Megan, Kovalchin John, Daniels Curt, Jacobs Hannah, Akoghlanian Shoghik
Pediatric Cardiology, The Ohio State University, Nationwide Children's Hospital, Columbus, USA.
Adult Congenital Heart Disease, The Ohio State University, Nationwide Children's Hospital, Columbus, USA.
Cureus. 2025 Jun 16;17(6):e86160. doi: 10.7759/cureus.86160. eCollection 2025 Jun.
Chest pain and syncope are common in adolescents and are usually benign, but they can also be indicative of potentially life-threatening cardiac conditions. We present a rare case of non-aorto-ostial Takayasu arteritis in an adolescent presenting with exertional chest pain and syncope that highlights the importance of considering uncommon diagnoses and conducting comprehensive diagnostic evaluations. The initial diagnostic workup including an ECG and echocardiogram were normal. An ECG stress test demonstrated ST changes consistent with ischemia. Advanced imaging techniques, including cardiac CT and cardiac stress MRI were essential for the accurate diagnosis and management of this patient. Cardiac CT revealed significant wall thickening of the left anterior descending (LAD) artery, consistent with coronary vasculitis, and cardiac stress MRI demonstrated reversible subendocardial ischemia and regional wall motion abnormalities in the LAD distribution. The rheumatologic work-up revealed no additional signs of vasculitis with normal inflammatory markers and unremarkable whole-body MRI. Medical induction therapy with cyclophosphamide and systemic corticosteroids resulted in significant improvement in LAD wall inflammation and thickness. However, the intraluminal LAD diameter remained severely narrowed. Therefore, the patient ultimately underwent coronary artery bypass surgery with a successful outcome and complete resolution of symptoms.
胸痛和晕厥在青少年中很常见，通常为良性，但也可能提示潜在的危及生命的心脏疾病。我们报告了一例罕见的非主动脉开口处高安动脉炎的青少年病例，该患者表现为劳力性胸痛和晕厥，突出了考虑罕见诊断和进行全面诊断评估的重要性。最初的诊断检查包括心电图和超声心动图均正常。心电图负荷试验显示ST段改变符合心肌缺血。先进的成像技术，包括心脏CT和心脏负荷磁共振成像对于该患者的准确诊断和治疗至关重要。心脏CT显示左前降支（LAD）动脉壁明显增厚，符合冠状动脉血管炎，心脏负荷磁共振成像显示LAD分布区域存在可逆性心内膜下缺血和节段性室壁运动异常。风湿学检查显示炎症指标正常且全身磁共振成像无异常，未发现血管炎的其他迹象。环磷酰胺和全身性皮质类固醇的药物诱导治疗使LAD动脉壁炎症和厚度有显著改善。然而，LAD动脉腔内直径仍严重狭窄。因此，患者最终接受了冠状动脉搭桥手术，手术成功，症状完全缓解。
