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Cardiovascular Images
January 29, 2020

A Woman in Her 20s With Chest Pain and Arm Claudication

Author Affiliations
  • 1National Heart & Lung Institute, Imperial College London, London, England
  • 2Division of Cardiovascular Medicine, University of Cambridge, Cambridge, England
  • 3Department of Radiology, Imperial College Healthcare NHS Trust, London, England
JAMA Cardiol. 2020;5(4):482. doi:10.1001/jamacardio.2019.5447

A 28-year-old woman presented with atypical chest pain and longstanding upper limb claudication. She had no cardiovascular risk factors. Radial and brachial pulses were absent and her blood pressure unrecordable. Computed tomography coronary angiography results revealed bilateral calcified coronary aneurysms (Figure, A) with significant proximal left anterior descending and right coronary artery stenoses immediately distal to the aneurysms. Magnetic resonance imaging results confirmed the underlying diagnosis of Takayasu arteritis with multiple artery occlusions, well-developed collaterals, and no evidence of active vasculitis (Figure, B). Stress echocardiography results excluded inducible myocardial ischemia. Known as “pulse-less” disease, Takayasu arteritis typically affects young women, resulting in granulomatous large-vessel vasculitis with arterial stenoses, occlusions, and aneurysms.1 Although the pattern of coronary disease in this case is highly unique, coronary involvement is not infrequent and is often overlooked.2 As there was no evidence for active vasculitis or myocardial ischemia identified, management was conservative.

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