A rare cause of non-atherosclerotic myocardial infarction: Rheumatoid arthritis
Ziya Şimşek 1 * , M. Hakan Taş, Emrah İpek
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1 Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
* Corresponding Author

Abstract

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.

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Article Type: Letter to Editor

https://doi.org/10.5799/ahinjs.01.2013.04.0348

J Clin Exp Invest, 2013 - Volume 4 Issue 4, pp. 568-569

Publication date: 14 Dec 2013

Article Views: 1135

Article Downloads: 349

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