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Specific Arterial Disease
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
This is a chronic occlusive disease affecting the aorta and its major branches and is caused initially by acute inflammatory arteritis (Sharma et al., 1992). It is most common in Asian populations and in women. It may present, as does aortic coarctation, with asymptomatic elevation of arterial pressure in the upper part of the body or may become apparent through detection of a low-amplitude or absent pulse in an arm. Symptoms may arise through disturbance of arterial conduit function—ischemia of a limb or organ or disturbance of cushioning function with early wave reflections as in aortic coarctation, elevated central aortic and LV pressure, leading on to cardiac decompensation. Medical treatment of the chronic stage depends on the specific defect; surgical treatment depends on the anatomic defect and the possibility of and need for correction. The same principles apply in the chronic obstructive stage of the disease as in aortic coarctation. It is well established today that Takayasu arteritis often leads to increased blood pressure, increased aortic stiffness and altered left ventricular mechanics (Ng et al., 2006; Grotenhuis et al., 2018)
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Which of the following are most likely to seen in a patient with a diagnosis of Takayasu arteritis in the healed fibrotic phase?Delayed enhancement of the aortic wallIrregular contour of the descending aortaLinear calcification of the ascending aortaLinear calcification of the descending aortaNarrowing of the peripheral arteries
Fever in Diseases of the Cardiovascular System
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Takayasu’s arteritis (aortic arch arteritis, pulseless disease)128-130 is a nonspecific arteritis with a worldwide distribution, occurring principally in young females. In its early stage the condition may present with protean manifestations, including unexplained fever, malaise, weight loss, night sweats, arthralgia, and myalgia. Occasionally, pleuritis, pericarditis, and Raynaud’s phenomenon are present. Nonspecific laboratory findings include anemia, leukocytosis, elevated serum gamma- and alpha-2 globulins and ESR. At a later stage features of arterial obstruction appear: loss of pulse of one or more vessels, bruit, hypertension (renal arterial involvement), syncope, impaired vision, paresthesiae, headache, limb pain, and hemiplegia. The diagnosis should be considered in young females with appropriate symptomatology and may be confirmed by arteriography. Timely use of immunosuppressive therapy may help to arrest the disease progress.
Updates in the diagnosis and management of Takayasu’s arteritis
Published in Postgraduate Medicine, 2023
Anupam Somashekar, Yiu Tak Leung
The clinical manifestations of Takayasu’s arteritis vary widely, ranging from asymptomatic pulseless disease to serious neurologic manifestations [28]. This wide spectrum of symptoms, as well as lack of specific serologic biomarkers often leads to a delay in diagnosis. Early in the disease course, patients have nonspecific symptoms including fevers, myalgias, fatigue, weight loss, night sweats and arthralgias. Later in the disease course, vessel narrowing and stenoses develop, with bilateral stenoses as the most common manifestation [24]. As inflammation progresses, patients can develop aortic aneurysm, pulmonary hypertension, renovascular hypertension, and retinopathy. In Ishikawa’s cohort of 96 patients with Takayasu’s arteritis, the three most common manifestations were limb signs or symptoms in 82 patients (85%), followed by hypertension and aortic regurgitation in 54% of patients [29]. Clinical exam findings include pulselessness, bruits, and blood pressure discrepancy between right and left arm [28]. Of note, women have been found to have more supradiaphragmatic vessel involvement compared to abdominal vessel involvement in male patients [30]. The subclavian artery is most involved followed by the common carotid arteries, but pulmonary artery, renal artery, ophthalmic and mesenteric artery involvement has been reported [28,31].
CT findings in aggressive Takayasu arteritis
Published in Acta Cardiologica, 2022
Benjamín Roque Rodríguez, Luis Enrique Lezcano Gort, María Victoria Mogollón Jiménez, Ignacio Díaz Villalonga, Sergio Moyano Calvente, Zineb Kounka
A 52-year-old woman was referred to our hospital with grade-2 dyspnoea without intermittent claudication. She complained of self-limiting episodes of fever, asthenia, and myalgias since the adolescence. Physical examination revealed a loud panfocal systolic murmur (IV/VI), and large inter-arm blood pressure difference (180/80-120/70 mmHg in right and left arm respectively). Treponema pallidum serological-test and autoantibodies were negative, and acute phase reactants were normal. Doppler echocardiogram reveals doubtful patent ductus arteriosus. CT angiography with multiplanar (Figure 1, panels 1 and 4) and volumen-rendered reformatted images (Figure 1, panels 2 and 3) showed severe narrowing of the middle segment of the descending thoracic/abdominal aorta (a), and both iliac arteries, with intima-media thickening in all of them (b). Collaterals have been developed, like a huge and tortuous right internal mammary artery which anastomoses with branches of the epigastric arteries (c). We found severe stenosis in common carotid arteries (critical in left common carotid artery) (d) and in both subclavian arteries at the ostia of vertebral arteries(e). On the basis of clinical and angiographic abnormalities, the diagnosis of Takayasu arteritis (TA) was made. TA is a large-vessel granulomatous vasculitis that primarily affects the aorta and its primary branches, specially supraaortic trunk and subclavian artery. It principally affects young women. The patient refused to take any treatment or perform new tests. Actually, she remains asymptomatic.
The diagnosis and management of temporal arteritis
Published in Clinical and Experimental Optometry, 2020
Melvin Lh Ling, Jason Yosar, Brendon Wh Lee, Saumil A Shah, Ivy W Jiang, Anna Finniss, Alexandra Allende, Ian C Francis
NA‐AION, as mentioned above, is caused by atherosclerosis and other vascular risk factors including hypertension, diabetes, smoking, and obstructive sleep apnoea. Both optic nerves are characteristically small and crowded, with a small cup‐to‐disc ratio (the so‐called ‘disc‐at‐risk’), and the disc demonstrates congestion and oedema without pallor.Takayasu arteritis is a large‐vessel vasculitis that may present with fever and constitutional symptoms. However, it usually affects younger patients and typically does not result in vision loss.Granulomatosis with polyangiitis, and polyarteritis nodosa, are small‐vessel vasculitides that may cause systemic and constitutional symptoms, but also rarely cause vision loss. However, the temporal artery is very infrequently involved.1994Other causes of unilateral optic nerve swelling and vision loss should be excluded if investigations for TA are negative. These include optic neuritis; infectious (including luetic), post‐infectious, or sarcoid optic neuropathy; and optic nerve neoplastic infiltration/extrinsic compression/drusen.