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
