title: [Acute coronary syndrom as a cardiac manifestation of granulomatosis  with polyangiitis].
abstract: METHODS
  A 49-year-old patient was admitted to our ward because of a troponin elevation (non ST-elevation myocardial infarction) following a rhinoscopy in an external hospital. The patient complained of typical angina, chronic rhinitis and epistaxis. Analysis of the nasal biopsy had shown the histological finding of granulomatosis with polyangiitis (Wegener's granulomatosis).
  
  
  METHODS
  The consecutively performed catheterization showed a coronary one-vessel disease without significant stenosis. Echocardiography showed diastolic dysfunction as well as hemodynamically not significant pericardial effusion. The MRI scan of the heart revealed multiple myocardial scars located ventricular apical and septal. Extended bilateral pulmonary opacities in the thoracic CT scan, microhematuria, leukocyturia and proteinuria indicated multi-organ involvement of the small vessel disease.
  
  
  METHODS
  The patient's condition improved quickly in response to steroids and cyclophosphamide, followed by attenuation of clinical symptoms and normalizing blood and renal parameters.
  
  
  CONCLUSIONS
  The prognosis of granulomatosis with polyangiitis is mainly limited by renal and pulmonal involvement. Cardiac involvement is commonly rare and associated with clinical courses refractory to immunosuppressive therapy. Generally, all cardiac structures can be affected, thereby impending serious cardiac events. Normally, granulomatosis with polyangiitis responds quickly to immunosuppressive therapy, associated with a rather good prognosis without higher mortality.
authors: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn. Tobias.Asdonk@ukb.uni-bonn.de
authors: T
authors: T
authors: Asdonk
authors: V
authors: V
authors: Tiyerili
authors: J
authors: J
authors: Dörner
authors: D
authors: D
authors: Thomas
authors: C
authors: C
authors: Schaefer
authors: D
authors: D
authors: Skowasch
authors: G
authors: G
authors: Nickenig
authors: S
authors: S
authors: Pabst
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003520:Cyclophosphamide / Q000627:therapeutic use; D006801:Humans; D008297:Male; D055953:Microscopic Polyangiitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D020293:Vasculitis, Central Nervous System / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D013256:Steroids; D003520:Cyclophosphamide