Eduardo Chávez

Myocardial Infarction in Patients with Systemic Lupus Erythematosus with Normal Findings from Coronary Arteriography and Without Coronary Vasculitis Case Reports

The authors present the cases of two young patients, a man and a woman, who presented with myocardial infarction, in the absence of ischemic heart disease or stenosis of the coronary arteries. The woman was known to have systemic lupus erythematosus (SLE) for the past 3 years (the immunoglobulin M [IgM] anticardiolipins antibodies were positive), without a history of coronary risk factors. Suddenly she presented with acute chest pain on rest that lasted 4 hours and culminated in anterior wall myocardial infarction. She was admitted to the coronary care unit, where no thrombolysis was given. She did not have echocardiographic evidence of Libman-Sacks endocarditis, but myocardial infarction was evident at the electrocardiogram (ECG) . The young man had SLE (the IgM anticardi olipins were absent, but he was positive for lupus anticoagulant antibodies), he was hyperlipidemic, was a moderate smoker and moderately obese, and had no history of ischemic heart disease. He suddenly presented with an acute myocardial infarction docu mented by ECG, enzymes, and gammagraphy. In both patients, coronary angiography findings were normal and myocardial biopsy did not show evidence of arteritis. The relevance of these cases is the rare association of ischemic heart disease in SLE, with normal coronary arteries and without evidence of arteritis or verrucous endocarditis.

Pulmonary Valvular Stenosis Associated with Takayasu's Disease. Favorable Response to Corticosteroids A Case Report:

The authors describe the first reported case of type IV Takayasus arteritis with pulmonary valve stenosis. After thirty months under corticosteroid therapy the disappearance of the pulmonary valve stenosis signs was observed in the patient. In the same patient coarcta tion of the aorta, aortic insufficiency, stenosis of both pulmonary arteries, and left coronary artery stenosis were observed. This case illustrates the extensive cardiovascular involvement that can occur in Takayasus arteritis and suggests that pulmonary valvular stenosis could be secondary to the same inflammatory process.

Extensive iatrogenic dissection of the aorta. Complications of retrograde arterial catheterization: a case report

The authors report a case of a forty-three-year-old woman with an extensive iatrogenic dissection of the aorta, from the iliac artery to the ascending aorta, not associated with atherosclerosis or previous aortic dissection, as a complication of retrograde arterial catheterization. The authors emphasize the need to take all cautions in performing this procedure to avoid serious complications such as the present one.