Cardiac manifestation of giant cell arteritis as a rare cause of severe coronary triple vessel disease

A 60-year-old Caucasian woman was referred for evaluation of new onset exertional dyspnea (New York Heart Association [NYHA] Functional Class II), heart failure with reduced ejection fraction (EF: 38%) of unknown etiology, as well as recurrent palpitations. Her past medical history was significant for giant cell arteritis confirmed by temporal artery biopsy 14 years earlier with associate aneurysms in multiple vascular beds, including the right temporal artery, branch of retinal artery, and distal radial artery, treated with steroids for one year. Pre-test probability for obstructive coronary artery disease was deemed intermediate and she underwent coronary computed tomography angiography (CCTA) for further evaluation. CCTA revealed severe lumen narrowing in all three coronary arteries with multiple aneurysms. Specifically severe stenoses or total occlusion of the distal left anterior descending coronary artery, proximal left circumflex artery and the posterior descending artery were observed (Fig. 1, panel A, B, C). In addition, CCTA demonstrated subendocardial myocardial hypoperfusion of the lateral and anterior left ventricular walls, suggestive of subendocardial myocardial ischemia (Fig. 1, panel D). Invasive coronary angiography was performed confirming the CCTA findings (Fig. 1, panel E and F). Considering the test results and her past medical history, her coronary disease was attributed to giant cell arteritis, reflecting a rare cardiac sequela of this disease. Shared decision making resulted in conservative management focused on guideline-directed medical therapy .