Vasculitis of the coronary arteries can cause acute thrombosis, result in myocardial infarction and sudden death.

Patient selection: sudden unexpected death


Clinical features:

(1) The patient may be known to have a vasculitis, but not always.

(2) The vasculitis may show a systemic distribution, or it may be localized to the heart.

(3) There is evidence of acute thrombosis of one or more coronary arteries.

(4) Microscopic examination shows evidence of a vasculitis, which may be necrotizing.


Evaluation may include:

(1) antinuclear antibodies

(2) IgG4

(3) anti-neutrophil cytoplasmic antibodies (ANCA)

(4) cryoglobulin


Differential diagnosis:

(1) polyarteritis nodosa

(2) Kawasaki disease

(3) microscopic polyangiitis

(4) granulomatosis with polyangiitis

(5) eosinophilic granulomatosis with polyangiitis

(6) Takayasu arteritis

(7) giant cell arteritis

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