title: What's wrong with this artery? A medical disease discovered by a surgeon.
abstract: A 50-year-old man presenting with chest pain had positive stress echocardiography; and angiogram showed single artery coronary stenosis, presumed to be atherosclerotic. He was started on optimal medical therapy with good compliance. Four months later, he had a myocardial infarction (MI) and cardiac catheterisation surprisingly showed interval development of severe three-vessel stenosis. He underwent coronary artery bypass grafting (CABG), during which the cardiothoracic surgeon noticed severely inflamed coronary arteries, concerning for vasculitis. Following CABG, the patient continued to have chest pain and was admitted again for MI within 4 months of surgery. Subsequent autoimmune workup was consistent with sarcoidosis. He was started on immunosuppressive therapy for presumed sarcoid-related coronary vasculitis, and 23 months later, the patient has not developed further ischaemic events. This is a rare case and extends the clinical spectrum of cardiac sarcoidosis, presenting with rapidly progressive coronary stenosis most likely due to vasculitis, mimicking atherosclerotic coronary artery disease.
authors.affiliation: Department of Internal Medicine, Unity Health System, Rochester, New York, USA.
authors.forename: Vasvi
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine, Unity Health System, Rochester, New York, USA.
authors.forename: Saurav
authors.initials: S
authors.lastname: Luthra
authors.affiliation: Department of Internal Medicine, Unity Health System, Rochester, New York, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kouides
authors.affiliation: Department of Internal Medicine, Unity Health System, Rochester, New York, USA.
authors.forename: Abdel K
authors.initials: AK
authors.lastname: Gadir
mesh_terms: D009202:Cardiomyopathies / Q000175:diagnosis* / Q000188:drug therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery; D004562:Electrocardiography; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
chemical_list: D007166:Immunosuppressive Agents