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A 62 year old woman presented with a six month history of exertional chest pain and dyspnoea on moderate exertion. She had no significant risk factors for ischaemic heart disease. A diagnosis of Takayasu's arteritis had been made 20 years previously when she presented with atypical chest pain, a low grade pyrexia, and unequal radial pulses. Angiography on this admission revealed good left ventricular function with severe ostial disease of both the right (below right) and left (below centre) coronary systems. Aortography demonstrated an occluded subclavian artery (below left), an ectatic descending aorta, and normal renal arteries. Following the procedure she developed chest pain which failed to settle with medical treatment and subsequently required urgent three vessel coronary bypass grafting.
The incidence of coronary artery disease in Takayasu's arteritis is low—reported to be between 9–10% from postmortem studies. When present, disease is most commonly confined to the ostial and proximal segments of the coronary arteries. Although rare a diagnosis of Takayasu's arteritis should be considered in patients with isolated ostial coronary lesions in the absence of significant risk factors.