MYOCARDIAL INFARCTION AS A CONSEQUENCE OF CHILDHOOD POLYARTERITIS NODOSA – CASE REPORT

Broj: 2, 2016 Rubrika: Prikaz bolesnika Autori: Viktorija Ana Buljević, Matias Trbušić, Diana Delić-Brkljačić, Ivan Malčić

Poliarteritis nodoza (PAN) sistemski je vaskulitis histološki karakteriziran nekrotizirajućim lezijama srednje velikih i malih arterija, ponajviše na njihovim bifurkacijama. PAN je multiorganski poremećaj koji zahvaća sve visceralne arterije te zbog posljedica upale i nekroze može dovesti do ishemije vitalnih organa. Etiologija bolesti je nepoznata. Postoje četiri oblika – kutani (koji je najčešći), klasični, sistemski i mikroskopski. PAN ponajprije zahvaća renalne i koronarne arterije. Najčešći nalaz zahvaćenih krvnih žila jesu aneurizme, tromboze i stenoze. Kardijalne su komplikacije
rijetke u djece, no u 35% bolesnika u odrasloj dobi razvije se neka komplikacija. Od tih je najčešća kardijalna dekompenzacija koja se objašnjava kao posljedica dugogodišnje hipertenzije te promjena na koronarnim krvnim žilama. Incidencija akutnog infarkta miokarda niska je, posebno u mladih bolesnika. U ovom radu opisan je 25-godišnji bolesnik s akutnim infarktom miokarda i promjenama na koronarnim krvnim žilama te perzistirajućom arterijskom hipertenzijom kao posljedicom dijagnosticiranog PAN-a u djetinjstvu.

Polyarteritis nodosa (PAN) is a systemic vasculitis histologically characterized by necrotic lesions of small and medium-sized arteries occurring mostly in their bifurcations. PAN is a multi-organ disorder that aff ects numerous visceral arteries and leads to infl ammation and necrosis, which may result in ischemia of vital organs. Th e etiology of the disease is unknown. It occurs in four forms – cutaneous (most common), classic, systemic, and microscopic. PAN preferably aff ects the renal and coronary arteries. Th e most common fi ndings in the aff ected blood vessels are aneurysm, thrombosis and stenosis. Cardiac complications are rare in children, but 35% of patients develop a complication in adulthood. The most common complication in adulthood is cardiac decompensation, which can be explained as a consequence of longstanding  hypertension and changes in coronary blood vessels. Th e incidence of myocardial infarction is low, particularly in young patients. Th is paper describes a 25-year-old patient with acute myocardial infarction accompanied by changes in the coronary blood vessels and persistent arterial hypertension as a result of PAN diagnosed in childhood.

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