A 59-year-old woman with visible precordial pulsations #MMPMID29101266
Moss AJ; Pessotto R; Flapan AD
Heart 2018[Feb]; 104 (3): 273-4 PMID29101266show ga
Clinical introduction: A retired 59-year-old woman presented to the cardiology clinic concerned with cardiac pulsations that were visible on her chest wall. These were not associated with dyspnoea, syncope or chest discomfort.Of note, 8?years previously, she complained of recurrent nocturnal diaphoresis and 5?kg weight loss. Blood sampling at that time revealed a microcytic anaemia, reactive thrombocytosis and raised inflammatory markers (erythrocyte sedimentation rate 99?mm/hour, C-reactive protein 161?mg/L). Following an episode of transient diplopia, ophthalmoscopy demonstrated a cotton wool spot in the left inferotemporal retinal arcade. She commenced a 2-year tapering course of 1?mg/kg prednisolone.On examination, she had a lean physique with a supine blood pressure of 162/60?mm Hg and palpable Corrigan?s pulse. She had a prominent apical pulsation and a loud early diastolic murmur was present at the left sternal edge radiating to the apex. Echocardiography showed severe central aortic regurgitation and a dilated aortic root (see online supplementary figure 1). Cardiac CT was performed to clarify the diagnosis (figure 1).10.1136/heartjnl-2017-312193.supp1Supplementary file 1Figure 1Contrast-enhanced CT of the thorax at index presentation (A) and 6?months (B). Prospective ECG-gated cardiac CT angiogram (75%?R-R interval) performed at 8?years from index presentation (C) with a stretched multiplanar reconstruction of the aortic annulus, aortic root and thoracic aorta (D). Question: Which of the following diagnoses best explains this presentation?Ankylosing spondylitisTakayasu arteritisSalmonellosisIgG4-related aortitisGiant cell aortitis
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Heart 2018 ; 104 (3): 273-4
