The heart in temporal arteritis / giant cell arteritis
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Overview
Giant cell arteritis (also known as temporal arteritis and granulomatous giant cell arteritis) may affect more than 1% of elderly population. Cardiac involvement is an uncommon and rare form of presentation. Patients with temporal arteritis / giant cell arteritis might have chest pain if they have aortic root involvement or myocardial infarction.
Granulomatous giant cell arteritis may occur independently or, more commonly, may be associated with temporal arteritis in 10-15% of patients.[1] [1] [1][1]
Histologically proven giant cell coronary arteritis is rare, and cases leading to fatal myocardial infarction are even rarer [1][1][1][1]
The arterial wall lesion is a granulomatous inflammation with giant cells found along a degenerative internal elastic membrane. [1] The intima becomes greatly thickened, and ultimately the vessel is converted into a fibrous cord.
Luminal thrombosis was also be present in 16 cases of temporal arteritis reported by Harrison [1][1]; only 1 case involved the epicardial coronary arteries. Giant cell arteritis of the intramural (intramyocardial) coronary arteries may also occur in association with temporal arteritis and giant cell arteritis. [1][1]
Vascular inflammation in giant cell arteritis can be widespread. Branches of the proximal aorta, especially those supplying the neck, extracranial structures of the head, and upper extremities, tend to be affected most prominently.
Extracranial vascular involvement is clinically detectable in 10-15% of patients with giant cell arteritis. It often presents dramatically as an unsuspected cause of aortic dissection or ruptured aortic aneurysm in the elderly [1]
CT scans and MRI with T2-weighted images are enough for diagnosis.
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
