Takayasu Arteritis Presenting With Cardiac Arrest

BACKGROUND: Acute coronary syndromes in young patients with minimal risk factors pose diagnostic dilemmas. We report a rare case of myocardial infarction and cardiac arrest caused by Takayasu arteritis. CASE SUMMARY: A 44-year-old Caucasian woman presented with chest pain, syncope, and ventricular tachycardia. Electrocardiogram showed global ischemia with ST-segment elevation in lead aVR. Coronary angiography revealed severe ostial left main coronary artery stenosis with intravascular ultrasound excluding atherosclerosis or dissection. Computed tomography angiography suggested large vessel vasculitis, and positron emission tomography excluded active inflammation. Through multidisciplinary input, a diagnosis of inactive "burnt-out" Takayasu arteritis was made. The patient underwent percutaneous coronary intervention and was managed without immunosuppression. DISCUSSION: Takayasu arteritis is a rare cause of coronary ischemia in adults. Coronary ostial stenoses without atherosclerosis or dissection on intravascular imaging should raise suspicion. A multidisciplinary approach alongside multimodal imaging improves outcomes. TAKE-HOME MESSAGE: This case highlights a rare cause of acute coronary syndrome in a young patient, the usefulness of coronary intravascular imaging when presented with discordant clinical and coronary angiographic findings, and the value of multimodality imaging and the multidisciplinary team.