Takayasu arteritis

Question 1

Takayasu arteritis

• Aka ‘pulseless disease’ or ‘aortic arch syndrome’
• Vasculitis of _______________
• Rare, except in ____________ (affects young Asian women)
• Unknown etiology

Answer 1

aorta and its major branches;

Japanese women, 10-40yo

Question 2

What are the general symptoms of Takayasu arteritis?

Answer 2

PC: constitutional symptoms - fever, malaise, weight loss (symptoms of vascular disease are rare at presentation)

Pain and tenderness over affected arteries

Arterial bruit (most commonly carotid, but also subclavian, axillary, renal and mesenteric)

Question 3

What are the symptoms if there is dilatation, narrowing or occlusion of subclavian artery proximal to origin of vertebral arteries?

Answer 3

Subclavian steal syndrome (light-headedness, syncope, neuro symptoms, BP & Pulse of limb, arm claudication) i.e. stroke, syncope & Acute limb ischaemia / Chronic limb ischaemia

Due to retrograde flow of blood in vertebral A

Question 4

What are the symptoms if there is dilatation, narrowing or occlusion of subclavian artery distal to origin of vertebral arteries?

Answer 4

• Limb claudication
• Marked absence/ asymmetrical weakening of peripheral pulses (esp radial)
• Discrepant arm BPs (≥10mmHg) -> measure BP In all 4 limbs

Question 5

What are the symptoms if there is dilatation, narrowing or occlusion of aorta?

Answer 5

• AR and AS

- HTN (-> malig HTN)

Question 6

What are the symptoms if there is dilatation, narrowing or occlusion of coronary artery?

Answer 6

• Angina -> AMI and death

- Heart failure

Question 7

What are the symptoms if there is dilatation, narrowing or occlusion of mesenteric artery?

Answer 7

Mesenteric ischaemia (abdo pain, diarrhoea, BGIT)

Question 8

What are the symptoms if there is dilatation, narrowing or occlusion of pulmonary artery?

Answer 8

• Pul haemorrhage: CP, SOB, haemoptysis

- Pul HTN (pulmonary artery involvement is common but manifestations are less common)

Question 9

What are the symptoms if there is dilatation, narrowing or occlusion of carotid and vert art
(↓cerebral blood flow)
?

Answer 9

Light-headedness, vertigo, syncope, orthostasis, headaches, convulsions, strokes

Question 10

What are the investigations to be performed for Takayasu arteritis?

Answer 10

↑ ESR/CRP – neither spef or sensitive

Renal – proteinuria, haematuria

MRA (MR Angiography), CTA (CT Angiography) of aorta – inflammatory thickening of aorta and branches

• Note: not angiogram (cannot assess arterial wall thickening)
• Note: not Doppler US (can only image superficial arts, and time consuming)

Question 11

What is the management of Takayasu arteritis?

Answer 11

Corticosteroids: mainstay of treatment

• Initial dose of 45-60mg pred OM + PPI and bisphosphonates – up dose in exacerbations, down dose if remission
• Suppresses constitutional symptoms, arrests progression of TKA
• If insufficient to maintain remission, consider adding immunosuppressant

Surgery (eg bypass, angioplasty): used to treat aortic or mitral regurgitation, coronary artery ostial lesions, aortic aneurysms, renal artery stenosis

Mx of heart failure, HTN and other complications