A 53-year-old Female with Sudden-Onset Chest Pain on a Background of Polyarteritis Nodosa
A 53-year-old previously healthy female patient presented with weakness in her lower extremities. She was initially suspected to have myasthaenia gravis and was started on pyridostigmine and prednisone. However, she subsequently developed sudden-onset chest pain and was admitted to the ED. An ECG was performed which showed ST-depression in leads I, aVL and V4-V6. Bloods also showed elevated cardiac troponin levels, leading to the diagnosis of NSTEMI. The patient's condition rapidly deteriorated soon after and she went into cardiogenic shock followed by cardiac arrest.
Despite rigorous resuscitation efforts, the patient's prognosis was deemed poor, leading to the decision to discontinue CPR. An autopsy was performed to determine the underlying cause of the cardiogenic shock and the examination revealed a transmural infarct throughout the entire left ventricle, as well as intimal thickening in the coronary arteries. Similar findings were observed in the kidney and GI arteries, consistent with a diagnosis of Polyarteritis Nodosa.
This patient’s ECG shows ST-depression in leads V4-V6 as well as in leads I & aVL. ST-elevation can also be seen in leads V1 & aVR.
Source: https://doi.org/10.3389/fcvm.2022.1070378
Case Summary & Questions written by Dr Ahmed Kazie
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