A Case of Recurrent Coronary Artery Restenosis Associated with Suspected Arteritis in a Young Woman

Case Report

Austin Crit Care Case Rep. 2021; 5(2): 1026.

A Case of Recurrent Coronary Artery Restenosis Associated with Suspected Arteritis in a Young Woman

Wanqing S, Hongliang Z* and Yongjian W

Department of Cardiology, Fuwai Hospital, China

*Corresponding author: Zhang Hongliang, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, 100037, Beijing, China

Received: February 09, 2021; Accepted: March 15, 2021; Published: March 22, 2021


Approximately 5% of patients with Acute Myocardial Infarction (AMI) do not have atherosclerotic Coronary Artery Disease (CAD) but present other factors responsible for luminal narrowing. A 24-year-old woman presented with angina and AMI without any known risk factors and recurrent coronary restenosis in the 7 year-follow-up period. Thorough tests revealed no suggestive factors besides increased amounts of tumor necrosis factor-a and interleukins. A diagnosis of arteritis was suspected. Therefore, glucocorticoid and immunosuppressor administration was performed, and the patient’s condition was relieved. Severe coronary artery disease with smooth distal coronary vessels in a young female without apparent risk factors could suggest a non-atherosclerotic etiology.

Keywords: Coronary artery disease; Acute myocardial infarction; In-stent restenosis; Arteritis; Glucocorticoid; Immunosuppressor


AMI: Acute Myocardial Infarction; CABG: Coronary Artery Bypass Grafting; CAD: Coronary Artery Disease; CAG: Coronary Angiography; DES: Drug-Eluting Stent; ECG: Electrocardiograph; ISR: Intra-Stent Restenosis; IVUS: Intravascular Ultrasound; LAD: Left Anterior Descending Artery; LCX: Left Circumflex Artery; LM: Left Main Coronary Artery; OCT: Optical Coherence Tomography; TA: Takayasu Arteritis


Atherosclerosis is the leading cause of Coronary Artery Disease (CAD) and Acute Myocardial Infarction (AMI). Approximately 5% of AMI patients do not have atherosclerotic CAD but present other factors causing luminal narrowing [1]. CAD and AMI are rarely diagnosed in young females. The diagnosis of severe CAD with smooth distal coronary vessels in a young woman without apparent risk factors could suggest a non-atherosclerotic etiology, e.g., congenital abnormality, coronary artery spasm, embolism, spontaneous dissection, drug abuse, syphilis, chest radiotherapy, Marfan syndrome, or autoimmune diseases [2].

Case Presentation

A 24-year-old woman presented in October 2012 with progressive tightening chest pain, with onset after walking fast about 50 meters and relief following a brief rest. She was otherwise healthy. Family history was unremarkable. She was admitted to a local hospital in November 2012 for persistent chest pain for 3h, accompanied by sweating, nausea and vomiting. Physical examination was unremarkable. Electrocardiograph (ECG) showed slightly elevated ST segment in chest leads V1-4, and limb leads I, avL and avR; poor R wave progression in chest leads V1-3; and high amplitude T wave in leads V2-4 (Figure 1A). T wave amplitude in leads V2-4 decreased 2h post-admission (Figure 1B). Laboratory tests showed slightly increased troponin and myocardial enzymes (cTNI, 1.2 ng/ml; CKMB, 27 IU/L; CK, 331 IU/L). Blood lipids, ESR, CRP, D-dimer, C3, rheumatoid factor and anti-streptolysin O were normal (Table 1). AMI was diagnosed until the next day with significantly increased troponin and myocardial enzymes; ECG showing QS wave in leads V1-3, I and avL, inverted T wave in leads V2-5, I and avL (Figure 1C); and segmental abnormal left ventricle anterior wall movement on echocardiogram. AMI was immediately treated with anticoagulation, antiplatelet and lipid lowering therapy with statin. Serological tests were negative for antinuclear antibodies, extractable nuclear antigens, anti-double stranded DNA antibodies, antineutrophil cytoplasmic or antiphospholipid antibodies, syphilis, hepatitis B and C virus, and human immunodeficiency virus.