Coronary arteritis

The oxidation hypothesis of atherosclerosis states that the oxidative modification of LDL (or other lipoproteins) is important and possibly obligatory in the pathogenesis of the atherosclerotic lesion thus, it has been suggested that inhibiting the oxidation of LDL will decrease or prevent atherosclerosis and clinical sequelae. LDL oxidation also has important implications for vascular health function. High concentrations of LDL may inhibit arterial function in terms of the release of nitric oxide from the endothelium and many of these effects are mediated by lipid oxidation products. Furthermore, oxidized LDL inhibits endothelium-dependent nitric oxide-mediated relaxations in isolated rabbit coronary arter-... 

Race—African-American Genetic Modifiable Hypertension Diabetes. Smoking Atrial fibrillation Coronary arter y disease Prior sb oke... 

Other situations Situations such as a pheochro-mocytomaand coronary arteritis secondary to systemic diseases, as Takayasu s disease, Kawasaki s disease, Churg-Strauss syndrome, etc., may generate myocardial ischaemia, ACS and even a myocardial infarction. This is also the case for patients with AIDS that often present diffuse and severe atherosclerotic lesions. 

Coronary arteritis and aortitis have also been found at autopsy... 

Cardiac involvement is rarely documented antemortem, but prevalence rates of 8% to 15% have been estimated (1,3,8,108). Any portion of the heart may be involved, but coronary arteritis and pericarditis are the most common features (108). Fatal arrhythmias (109), conduction defects (110), cardiomyopathies (3), and valvulitis (108) have been noted. 

Parry SD, Clark DM, Campbell J. Coronary arteritis in Wegener s granulomatosis causing fatal myocardial infarction. Hosp Med 2000 61(4) 284-285. 

Heart involvement develops in up to 60% of CSS patients (1). In the French Vasculitis Study Group (FVSG) experience, heart disease was found in 39 of 112 (35%) patients, including 28 patients with pericarditis and 27 with cardiomyopathy (3). Heart disease can involve the myocardium, pericardium, and at lesser degree, endocardium (28) and, in earlier studies, represented the major cause of death, accounting for about 48% of deaths (28,29) and morbidity. Myocarditis (caused by different or perhaps associated mechanisms, including eosinophilia, coronary arteritis, and fibrosis) can lead to restrictive (29), congestive (30), or dilated cardiomyopathy (30,31). Pericardial effusion occurs in up to 22% of CSS patients. CS usually control pericarditis but relapses may occur. 

Petrie MC, Padmanaban N, McDonald JE, Hillier C, Connell JMC, McMur-ray J J V. Angiotensin converting enzyme (ACE) and non-ACE dependent angiotensin II generation in resistance arteres from patients with heart failure and coronary heart disease. J Am Coll Cardiol 2001 37 1056-1061. 

Pregnancy (ergotamine s powerful uterine stimulant actions may cause fetal harm) hypersensitivity to ergot alkaloids peripheral vascular disease (eg, thromboangiitis obliterans, leutic arteritis, severe arteriosclerosis, thrombophlebitis, Raynaud s disease) hepatic or renal impairment severe pruritus coronary artery disease hypertension sepsis. The use of potent CYP3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandomycin, ketoconazole, itraconazole) with dihydroergotamine is contraindicated. 

Contraindications Coronary artery disease, hypertension, impaired liver or renal function, malnutrition, peripheral vascular diseases, such as thromboangiitis obliterans, syphilitic arteritis, severe arteriosclerosis, thrombophlebitis, Raynaud s disease, sepsis, severe pruritus... 

Loehrer FMT, Angst CP, Haefeli WE, Jordan PP, Ritz R, Fowler (1996) Low whole-blood S-adenosylmethionine and correlation between 5-methyltetrahydrofolate and homocysteine in coronary artery disease. Arter Thromb Vase Biol 16 727-733... 

This report highlights the risk of cardiovascular adverse effects with short courses of glucocorticoid therapy in elderly patients with inflammatory bowel disease, even with rather low-dosage regimens. Acute myocardial infarction occurred in an old man with coronary insufficiency and giant cell arteritis after treatment with prednisolone (SEDA-10, 343) but could well have been coincidental. 

Jones, H. B., Macpherson, A., Betton, G. R., Davis, A. S., SiddaU, R., and Greaves, P. (2003). Endothehn antagonist-induced coronary and systemic arteritis in the beagle dog. Toxicol Pathol 31, 263-72. 

Kreidstein SH, L3dwyn A, Keystone EC. Takayasu arteritis with acute interstitial pneumonia and coronary vascuhtis expanding the spectrum. Arthritis Rheum 1993 36(8) 1175-1178. 

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