Giant cell arteritis as a cardiovascular entity

A 66-year-old previously healthy female patient presented with symptoms of fatigue, anorexia and low-grade fever. She had no claudication, headache or muscle weakness. She was a non-smoker, did not use any alcohol and had no family history of cardiovascular disease. On clinical examination we saw an anaemic Caucasian woman with a blood pressure of 145/75 mmHg with a regular pulse of 75 beats/min. On examination of the heart there were normal heart sounds with a grade III early systolic murmur radiating to the carotid arteries. Peripheral pulsations were palpable and of normal volume. Examination of the lungs and abdomen was unremarkable and on inspection of the skin we found no stigmata of endocarditis. Laboratory investigation revealed a normocytic anaemia (haemoglobin 4.7 mmol/l) and an acute phase reaction with thrombocytosis (535/nl), elevated erythrocyte sedimentation rate (ESR, 128 mm/h) and elevated C-reactive protein (135 mg/l). Electrocardiogram and chest X-ray were normal. In two anaerobic bottles out of six blood cultures Bacterium proprioni acnes was grown. Transthoracic echocardiography showed a hyperdynamic left ventricle and severe concentric myocardial hypertrophy. The ascending aorta was not dilated. The aortic valve was tricuspid with calcified cusps and a moderate aortic insufficiency. On the aortic side of the valve a possible vegetation was visualised. …