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Coronary arteritis — Clinical Guidelines

Overview

Coronary arteritis refers to inflammation of the coronary arteries, which can lead to significant myocardial ischemia and potentially sudden death, often presenting as a pseudotumoural fibromyxoid lesion 2. It can occur independently or in conjunction with other cardiovascular pathologies 8.

Diagnosis

Clinical Presentation: Sudden death, ischemic heart disease symptoms 2.

Autopsy Findings: Macroscopic white areas in myocardium, microscopic fibroinflammatory changes in coronary arteries 2.

Imaging: Not explicitly detailed in provided abstracts; typically includes echocardiography and coronary angiography in clinical settings.

Laboratory Tests: Elevated acute phase proteins (CRP, SAA, AGP, Hp) may support diagnosis 6.

Histopathology: Essential for definitive diagnosis, showing inflammatory infiltration and vascular wall destruction 2.

Management

First-Line Treatments: Not explicitly detailed in provided abstracts for human coronary arteritis.

Adjunctive Therapies: In veterinary context, refractory cases may involve surgical resection and novel treatments like topical tacrolimus 3.

Monitoring: Serial monitoring of acute phase proteins can help assess disease activity 6.

Special Populations

Comorbidities: Coronary arteritis can coexist with other cardiovascular diseases, arteriosclerosis, and fatty liver changes 8.

Veterinary Context: Specific treatments like CO2 laser therapy and tacrolimus have shown efficacy in refractory canine dermal arteritis 1 3.

Key Recommendations

Autopsy and Histopathological Examination: Essential for confirming diagnosis in cases of unexplained death or sudden cardiac events 2 8 (Evidence: Strong).

Monitor Acute Phase Proteins: Useful for supporting diagnosis and monitoring treatment response in suspected cases 6 (Evidence: Moderate).

Consider Multimodal Treatment Approaches: In refractory cases, combining surgical interventions with immunomodulatory therapies may be beneficial, particularly in veterinary settings 3 (Evidence: Weak).

References

1 Santoro D. Successful Use of a Single Carbon Dioxide (CO. Veterinary dermatology 2026. link 2 Gabarrou G, Guilbeau-Frugier C, Blanc A, Telmon N, Savall F. Sudden Death Due to Coronary Arteritis. Journal of forensic sciences 2018. link 3 Banovic F, Jerry C, Howerth E. Tacrolimus therapy for dermal arteritis of the nasal philtrum refractory to surgery and anti-inflammatory therapy (doxycycline/niacinamide and topical fluocinolone) in a dog. Veterinary dermatology 2018. link 4 Roerig A, Carlson R, Tipold A. Evaluation of a microsphere-based immunofluorescence assay for the determination of Immunoglobulin A concentrations in cerebrospinal fluid of dogs. Research in veterinary science 2013. link 5 Maiolini A, Carlson R, Schwartz M, Gandini G, Tipold A. Determination of immunoglobulin A concentrations in the serum and cerebrospinal fluid of dogs: an estimation of its diagnostic value in canine steroid-responsive meningitis-arteritis. Veterinary journal (London, England : 1997) 2012. link 6 Lowrie M, Penderis J, Eckersall PD, McLaughlin M, Mellor D, Anderson TJ. The role of acute phase proteins in diagnosis and management of steroid-responsive meningitis arteritis in dogs. Veterinary journal (London, England : 1997) 2009. link 7 Nagi-Miura N, Harada T, Shinohara H, Kurihara K, Adachi Y, Ishida-Okawara A et al.. Lethal and severe coronary arteritis in DBA/2 mice induced by fungal pathogen, CAWS, Candida albicans water-soluble fraction. Atherosclerosis 2006. link 8 Carson HJ, Feickert BL. Coronary arteritis diagnosed at autopsy: three case reports and review of the literature. The American journal of forensic medicine and pathology 2000. link 9 Ohkuni H, Todome Y, Yokomuro K, Kimura Y, Ishizaki M, Fukuda Y et al.. Coronary arteritis in mice after systemic injection of bacterial cell wall peptidoglycan. Japanese circulation journal 1987. link 10 Lehman TJ, Walker SM, Mahnovski V, McCurdy D. Coronary arteritis in mice following the systemic injection of group B Lactobacillus casei cell walls in aqueous suspension. Arthritis and rheumatism 1985. link

Coronary arteritis