Giant cell arteritis may involve the coronary arteries, causing acute myocardial infarction and/or sudden death.
Clinical features:
(1) chest pain
(2) acute myocardial infarction
(3) sudden death
(4) evidence of giant cell arteritis in typical areas (temporal arteries, etc)
(5) polymyalgia rheumatica
(6) giant cell aortitis (with dissection, aneurysm or rupture)
Imaging studies such as angiography or intravascular ultrasound (IVUS) may show abnormalities of coronary arteries.
Histologic sections may show evidence of giant cell arteritis with:
(1) disruption of the internal elastic lamina
(2) mixed cellular infiltrate wtih plasma cells, histiocytes and giant cells
(3) inflammation and/or fibrosis in the adventitia.
However, involvement may be patchy so multiple sites may need to be examined.
The diagnosis requires exclusion of other causes of vascular disease. However, mixed giant cell arteritis and atherosclerosis can occur in an older adult.
