Three Vessel Disease with Left Main Involvement: A Rare Manifestation of Takayasu’s Arteritis

Background: Takayasu’s arteritis is a chronic vasculitis of unknown etiology affecting large vessels. Coronary involvement is rare and myocardial infarction as a presenting symptom has only been described in case reports. Case: We report a case of a 19 year old female diagnosed with Takayasu’s arteritis 2 years prior who came in due to chest pain and heart failure symptoms. ECG showed diffuse ischemia with ST elevation of the inferior wall. Coronary angiogram showed 3 vessel disease with left main involvement. Patient was started on high dose steroids. She then developed an acute stroke in the right posterior cerebral artery territory. She improved with Methylprednisolone pulse therapy and oral methotrexate. She was discharged on Prednisone, Methotrexate and cardiac medications and is stable on follow up. Diagnostics: Coronary angiogram showed ostioproximal stenosis of the distal left main segment, the proximal left anterior descending artery and the proximal left circumflex artery, with the right coronary artery being totally occluded. Two dimensional echocardiogram showed an ejection fraction of 38 percent with multisegmental wall motion abnormalities. CT aortogram showed segmental narrowing of the infrarenal abdominal aorta with multiple ostioproximal stenosis of several aortic branches with extensive collateral formation. MRI showed acute infarction in the right thalamus,right medial temporal and occipital lobes and right cerebellar hemisphere and vermis Conclusion: Takayasu’s arteritis can present with a myriad of vascular complications. The reported incidence of coronary involvement is low. This case highlights the progressive and unpredictable nature of this disease. A high index of clinical suspicion, as well as a meticulous search for the extent of disease severity allows the clinician to individualize treatment options for these patient

Correlation between severity of ultrasonographic nonalcoholic fatty liver disease and cardiometabolic risk among Filipino wellness patients

Introduction: Nonalcoholic fatty liver disease (NAFLD) is a prevalent condition which is known to be related to factors that predispose to the development of coronary artery disease as well as development of metabolic syndrome. The study aimed to determine the association between ultrasound-based grading of hepatic steatosis with metabolic profile and estimated cardiovascular risk using the Framingham Risk Score (FRS). Methods: This was a cross-sectional study on 100 Filipino patients without established cardiovascular disease who underwent a general wellness health evaluation. Cases with NAFLD diagnosed on the basis of ultrasound grading were analyzed. Comparison of demographics and metabolic parameters between grades of hepatic steatosis was performed using Kruskal Wallis test. FRS was used to assess cardiovascular risk with Spearman rank test for correlation with the degree of NAFLD. Results: Mean age was 47 ± 9.6 years, with 70% males. Mean body mass index (BMI) was 28.7 ± 5.1. Most patients had grade I NAFLD (53%), 34% were grade II, and 13% were grade III. BMI (P =0.034), liver enzymes (alanine aminotransferase [ALT], P = 0.001; aspartate aminotransferase [AST], P = 0.00), triglycerides (P = 0.047), and fasting blood sugar [FBS] (P = 0.049) were associated with fatty liver grade. No association was noted with total cholesterol (P = 0.569), high density lipoprotein (HDL) (P = 0.220), and low density lipoprotein (LDL) (P = 0.792). Using the FRS 43% were stratified as low (20% risk). Severity of fatty liver was directly correlated with the FRS (Spearman rank 0.741, P = 0.009). Conclusion: Ultrasound-based grading of the severity of NAFLD is associated with abnormalities in the metabolic profile of patients. The FRS is correlated with increasing severity of NAFLD based on ultrasound. These findings suggest that the presence of NAFLD may be a marker for the presence of increased cardiovascular risk and may help identify patients who may benefit from more aggressive therapies to prevent development of adverse cardiovascular events