Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (38 page)

   Vasculitis describes a heterogeneous group of disorders that are characterized by leukocyte migration in the vessel wall resulting in damage of blood vessels, which leads to tissue ischemia and necrosis.

   Epicardial coronary vasculitis is relatively rare but can be life threatening. Coronary arteries are involved through either direct extension or hematogenous spread.

   Cardiac manifestations are rarely predominant in vasculitis and are just as likely to occur as a result of other organ involvement or treatment side effects of this systemic process.

   Heart failure due to direct myocardial involvement, ischemic cardiomyopathy, or valvular involvement in vasculitis is more common than ACS-like presentation.

   Size and shape of both arteries and veins are affected due to a primary process or secondary to an underlying pathology.

   Classification By

Etiology

   Primary: polyarteritis nodosa, Wegener granulomatosis, giant cell arteritis, hypersensitivity vasculitis (see Chapter
2
, Autoimmune Diseases)

   Secondary

   Infections: bacteria (e.g., septicemia caused by gonococcal organisms or
Staphylococcus
), mycobacteria, viruses (e.g., CMV, hepatitis B),
Rickettsia
(e.g., Rocky Mountain spotted fever), spirochetes (e.g., syphilis, Lyme disease)

   Associated with malignancy (e.g., multiple myeloma, lymphomas)

   Connective tissue diseases (e.g., RA, SLE, Sjögren syndrome)

   Diseases that may simulate vasculitis (e.g., ergotamine toxicity, cholesterol embolization, atrial myxoma)

Size of Involved Vessel (Noninfectious Vasculitis)

   Large vessel: dissection of aorta (dissecting aneurysm), Takayasu arteritis, giant cell (temporal) arteritis