A rare cause of non-atherosclerotic myocardial infarction: Rheumatoid arthritis

• Main Authors: Ziya Şimşek, M. Hakan Taş, Emrah İpek
• Format: Article
• Language: English
• Published: Modestum Publishing LTD 2013-12-01
• Series: Journal of Clinical and Experimental Investigations
• Subjects: amyloidosis; vasculitis
• Online Access: http://www.jceionline.org/upload/sayi/19/JCEI-00735.pdf

Cardiovascular involvement is common in rheumatoid arthritis [1]. Pericarditis, cardiomyopathy, myocarditis, cardiac amyloidosis, coronary vasculitis, arrhythmias, valvular heart disease and congestive heart failure due to ischemia can be seen in addition to the classical extra-articular involvement [2]. Patients with rheumatoid arthritis are under risk of accelerated atherosclerosis and myocardial infarction due to increased inflammation. Endothelial dysfunction is an important mechanism for thrombosis in these patients [3]. Pro-inflammatory cytokines (interleukin-1 beta and tumor necrosis factor alpha, C-reactive protein), activated coagulation factors (tissue factor, von Willebrand factor and plasminogen activator inhibitor-1), increased activity of cell adhesion molecules (selectins, vascular adhesion molecule-1, intercellular adhesion molecule-1) and matrix metalloproteinases are responsible for this endothelial dysfunction leading thrombosis [3]. The risk is especially higher in patients who have used or are using glucocorticoids [4]. In patients with Cushing’s syndrome due to chronic steroid use, accumulation of cardio-metabolic risk factors like visceral obesity, hypertension, hyperglycemia and hyperlipidemia results in acceleration of cardiovascular disease [4]. Additionally, a hypercoagulability state was also detected in patients with endogenous Cushing’s syndrome [5]. Herein we present a patient with rheumatoid arthritis who had extensive coronary thrombosis and was given steroid therapy for a long time. J Clin Exp Invest 2013; 4 (4): 568-569