Speaking about a 51-year-old woman from Mumbai who has suffered at least five heart attacks and undergone six angioplasties in less than two years and was recently brought under his treatment, Dr Hasmukh Rawat, senior consultant, interventional cardiology, Fortis Hospital, Mulund, Mumbai, informs, “We have decided to focus on the primary treatment of vasculitis instead of performing more angioplasties.”
Vasculitis is a rare condition in which the arteries are prone to frequent inflammation leading to a high risk of vascular damage, including plaque buildup and obstruction of smooth blood circulation, adds Dr Rawat.
Vasculitis and inflammation in the arteries
According to the Vasculitis Foundation, Kansas City, USA, vasculitis is a compilation of at least 20 conditions affecting arteries and blood vessels in different parts of the body, including the coronary artery. The underlying mechanism is the same as all these conditions — it involves inflammation in the blood vessels, leading to the narrowing of arteries and impaired blood flow. “Vessel wall inflammation or vasculitis may involve the arteries of the heart, causing a heart attack or brain, causing a stroke. Ir may also involve artery blockage anywhere in the body, causing disease in that particular organ,” explains Prof Dr Dennis McGonagle, Investigative Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, England, in an email interaction with Happiest Health.
Dr Rawat also points out that vasculitis could manifest in any of the arteries in the body. “It is actually quite rare to see someone with vasculitis in the coronary arteries. The condition is more common in the blood vessels in the eye or elsewhere in the body. This is the first time I came across someone with this condition, who has undergone multiple cardiac procedures,” Dr Rawat adds.
Arterial inflammation is also the underlying reason for multiple complications, including high blood pressure, plaque formation and increased risk of clot formation (prothrombotic state). These issues are among the highest risk factors that could lead to heart attack and brain strokes.
Case study: Sixteen months and six angioplasties
Dr Rawat points out the interesting case of the woman from Mumbai, who already had multiple angioplasties due to acute chest pain and heart attacks due to impaired blood circulation. “We performed an emergency angioplasty on her last July. We had specifically asked her to follow up on her condition in detail since it is not common for someone to suffer blockages in the heart frequently,” shares Dr Rawat.
He adds that the woman hailing from a well-to-do family was not under any stress or duress; rather, she happens to be a jovial individual with an active lifestyle. She also does not have a history of the usual heart attack risks including diabetes and hypertension. Dr Rawat shares, “We had also recommended visits to specialists including rheumatologists and immunologists. However, we now performed a thorough evaluation. A PET scan revealed inflammation in her arteries near the aorta,” Dr Rawat adds.
Treating and managing Vasculitis
According to the Vasculitis Foundation, the version of vasculitis triggering inflammation in the aorta carrying oxygenated blood to the rest of the body is also called aortitis. This could lead to weakness in the limbs, heart attack and heart failure along with renal complications.
Dr Rawat also adds that doctors are now focussing on bringing her inflammation under control by putting her on a course of steroids and other related therapy. Her inflammation has been formally considered the primary risk factor for her cardiac condition.
“When it comes to ischemic heart attack or conditions, the best form of treatment is to identify and curtail the primary cause of the condition. For some people, it could be uncontrolled diabetes. In this case, it is inflammation due to vasculitis,” informs Dr Rawat.
Prof Dr McGonagle also points out that people with vasculitis will be predisposed to higher risks of heart attacks and brain strokes if their arteries are already blocked due to atherosclerosis. People diagnosed with vasculitis are always asked to adopt a heart-healthy lifestyle and avoid smoking and alcohol consumption to minimize their risk of health complications including heart attack and coronary heart disease.
“Vasculitis may be autoimmune but can also be what is called innate immune driven (based on the immunity one has from birth). Appropriate targeting of autoimmune or innate immune pathways may reduce the risk of complications, especially with early and timely therapy. Modern therapy that relies less on high-dose corticosteroids may also be beneficial,” says Prof Dr McGonagle.
Vasculitis and the Covid-19 impact
According to the US government’s National Heart, Lung and Blood Institute (NHLBI), apart from autoimmune conditions like rheumatoid arthritis and lupus, Covid-19 is one of the main medical conditions that could trigger vasculitis. However, Dr Rawat points out that vasculitis affecting the heart is a rare thing.
Doctors observed a rise in the number of younger people with cardiac complications during the pandemic. However, further studies are required before confirming if there was an impact of the pandemic on heart attacks. Prof Dr McGonagel adds, “Covid-19 is linked to clotting in the blood vessel cavity and inflammation in the arteries including those around the heart. This is still incompletely understood. Some types of vasculitis may be slightly more common after Covid.”
Takeaways
- Vasculitis is an autoimmune condition that triggers inflammation in the arteries, causing them to narrow down, affecting proper blood circulation. It is a rare condition with different variants.
- When inflammation gets triggered in the aorta, it is called aortitis.
- People with vasculitis should take extra precautions to ensure a heart-healthy lifestyle as any form of atherosclerosis could put them at higher risk of health complications, including heart attacks.
- Experts suggest a healthy lifestyle and medications under expert supervision as options to manage this condition.
