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LETTER TO EDITOR
Year : 2019  |  Volume : 8  |  Issue : 1  |  Page : 40

Takayasu's Arteritis: Cardiac and Renal Involvement


Adjunct-Professor of Internal Medicine, Catholic University Medical Course; Department of Internal Medicine, Armed Forces Hospital, Brasília-DF, Brazil

Date of Web Publication23-Apr-2019

Correspondence Address:
Prof. Vitorino Modesto dos Santos
Department of Internal Medicine, Armed Forces Hospital, Estrada do Contorno do Bosque s/n, Cruzeiro Novo, 70658-900, Brasília-DF
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/rcm.rcm_1_19

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How to cite this article:
dos Santos VM. Takayasu's Arteritis: Cardiac and Renal Involvement. Res Cardiovasc Med 2019;8:40

How to cite this URL:
dos Santos VM. Takayasu's Arteritis: Cardiac and Renal Involvement. Res Cardiovasc Med [serial online] 2019 [cited 2019 Aug 23];8:40. Available from: http://www.rcvmonline.com/text.asp?2019/8/1/40/256875



Dear Editor,

I read the recent article by Khajali et al. about Takayasu's arteritis with cardiac involvement and renal artery stenosis in a 34-year-old male presenting heart failure (cardiomegaly, lung edema, and pleural effusion), anuria, and elevated creatinine level.[1] Echocardiographic study revealed marked dilatation and generalized hypokinesia in the left ventricle, and cardiovascular magnetic resonance imaging showed criteria for myocarditis. The sequential angiographic studies revealed stenosis at the ostium of both renal arteries, which is related to malignant hypertension, severe renal damage, heart failure, and death. The authors suggested more attention to evaluation of renal artery involvement in these patients because early diagnosis and adequate treatment can propitiate better prognosis.[1]

Considering that Takayasu's arteritis less often involves the heart and kidneys, one should add comments on two Brazilian case studies about this uncommon disease.[2],[3] Santos et al. described a 17-year-old woman with Takayasu's arteritis associated with cardiac and renal changes confirmed by complementary examinations and autopsy. She had chronic discrete fever, loss of appetite, dizziness, headache, right arm claudication, unsteadiness, in addition to visual changes consistent with the subclavian steal syndrome. Physical examination showed heart rate: 112 bpm; blood pressure (on left arm): 200/120 mmHg; normal arterial pulses on the left arm, while arterial pulses and blood pressure were undetected on the right arm. Electrocardiogram (ECG) showed left ventricle hypertrophy and first-degree atrioventricular block, and hypertensive retinopathy Grade 2 was detected. Blood tests (normal range in parenthesis) revealed urea (10–50): 54 mg/dL and creatinine (0.6–1.3): 1.3 mg/dL. After admission, she abruptly had irreversible acute heart failure and death. Autopsy showed pulmonary thrombosis and infarction; myocardial hypertrophy and thrombi within the right ventricle; and Takayasu's arteritis in the aorta and subclavian and renal arteries; and histopathology of kidneys detected diffuse glomerular sclerosis.[2]

Arruda Junior et al. reported a 24-year-old woman with clinical diagnosis of Takayasu's arteritis confirmed by arteriography images and histopathologic findings.[3] Clinical manifestations were left coronal ulceration on the scalp with bone involvement; on comparison to the above-cited study, the ECG and the urea and creatinine levels were normal. Her echocardiogram showed cardiac normal parameters and the angio-resonance of renal arteries did not reveal alterations; angio-tomography detected stenosis of brachiocephalic trunk, common carotids, and right subclavian, as well as occlusion of the left subclavian. The ulcer on the scalp was finally controlled by hyperbaric oxygen therapy and surgery.[3] Takayasu's arteritis affected the young females with different manifestations; the presence or not of cardiac and renal changes was based on images and clinical and pathology findings.

Suspected or confirmed cases of Takayasu's arteritis must be evaluated for cardiac or renal involvement. The author believes that case studies may increase the knowledge about scarcely reported conditions, and autopsy evaluation can better clear rare diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khajali Z, Futuhi F, Sadeghipour P, Arabian M, Aliramezany M. Unusual presentation of Takayasu's arteritis with cardiac involvement and renal artery stenosis. Res Cardiovasc Med 2018;7:207-9.  Back to cited text no. 1
  [Full text]  
2.
Santos VM, Gouvêa IP, Vasconcelos AV, Benevenuto G, Barcelos MS, Teles LT. Takayasu's arteritis associated with tuberculosis? Clinical and autopsy data. Brasília Med 2009;46:1-5.  Back to cited text no. 2
    
3.
Arruda Junior ZC, Santos VM, Monteiro LM, Santos AM, Silva FH, Ribeiro KR. Takayasu's arteritis and ulceration of the scalp in a 24-year-old woman. Brasília Med 2013;50:168-73.  Back to cited text no. 3
    




 

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