Takayasu's Arteritis Presenting as Acute STEMI

An 18-year-old man with past medical history of secondary arterial hypertension diagnosed at age 15 presented with an abdominal magnetic resonance imaging (MRI) that exhibited left renal artery stenosis. He received management with propranolol with complete improvement. However, he subsequently consulted due to oppressive chest pain. Electrocardiogram displayed anterolateral STsegment elevation myocardial infarction (STEMI). Hours after admission, he presented with a 10-minute cardiorespiratory arrest with pulseless ventricular tachycardia, requiring defibrillation to return to sinus rhythm. After the episode, he underwent emergent coronary angiography that diagnosed a saccular aneurysm of the left main coronary artery with ostial occlusion of the left anterior descending artery, in addition to a 70% severe lesion in the atrioventricular branch that originated from the circumflex artery (Figure, Video). Stabilization was achieved by an intra-aortic balloon pump.