Polyarteritis nodosa in the adult. Report of a case with repeated myocardial infarction and a review of cardiac involvement.

A young Coloured man with a history of acute transmural anteroseptal and anterolateral myocardial infarction presented with angina pectoris. Skeletal muscle biopsy showed unequivocal evidence of polyarteritis nodosa. Complete cardiac catheterization, left ventricular cine angiography, and selective coronary arteriography demonstrated a large aneurysm involving the apex and the left ventricular free wall. Diffuse aneurysmal dilatation of the right coronary artery was noted, as well as very severe obstructive lesions of the proximal left anterior descending and left circumflex coronary arteries. Five days after cardiac catheterization the patient suffered an acute transmural inferior myocardial infarction, complicated by acute pericarditis and complete heart block, which necessitated insertion of a pacemaker. This was soon followed by acute perforation of a peptic ulcer (documented at laparotomy), after which the patient died. As far as the author can ascertain, this is the first adult with polyarteritis nodosa (PAN) who underwent cardiac catheterization and selective coronary arteriography. The literature on cardiac involvement in the adult with PAN is reviewed.