Vasculitis and Cardiomyopathy

[Miacaro45]

Over a year ago, I wrote about having a blood clot in my left anterior descending artery. I had a catherization and was told that all the other arteries were clear. At that time, I asked the cardiologist if he thought there was any tie in with GCA and PMR. He could not give me an answer.

Three weeks ago, I had another cardiac event called Takotsubo cardiomyopathy. Again, I asked this new cardiologist the question about GCA and PMR, He had no answer. I think that there is a relationship between GCA and cardiac events. I would love your opinion.

Thank you all for your expertise, dedication and support.

[DorsetLady PMRGCAuk volunteer]

Maybe have a look at this from the FAQs- not sure if there is a direct relationship in your situation, but there is a connection with GCA-LVV and aorta-

healthunlocked.com/pmrgcauk...

[Miacaro45 in reply to DorsetLady]

Thank you

[PMRpro Ambassador]

In the past they haven't really linked PMR/GCA to cardiovascular events but there is an increased incidence of atrial fibrillation associated with them. I had asked the question of Prof Mackie after I was diagnosed and I know that the autoimmune part of PMR is the most likely cause of my a/fib according to the cardiologist. She didn't think there was - they both occur in similar aged populations. Since then, a study has linked them. There is also some thought that Takotsubu/broken heart syndrome may have autoimmune origins - if you have one autoimmune disorder you are more likely to develop another:

ncbi.nlm.nih.gov/pmc/articl....

What is possible is that the inflammation in the arteries in GCA causes damage to the endothelium - leading to an increased likelihood of any clots catching on the rougher surface. An increase in VENOUS thromboembolism has been noted and in the early stages after diagnosis I'm pretty sure there is an increased risk of stroke and heart attack but I thought that then falls over time with successful management of the inflammation.

onlinelibrary.wiley.com/doi...

It is a very brave doctor who says never ...

[Miacaro45 in reply to PMRpro]

I do have autoimmune diseases (Hashimotos, psoriasis, Intestitial Cystitis, Raynaud’s, etc). Thank you

[AtopicGuy in reply to Miacaro45]

...and GCA, which is another autoimmune disease to add to your list. Each one you have increases the risk of gaining another.

[piglette]

As PMRPro says, I have thought there may be a link between AF and PMR/GCA. I assume no one can answer you, as no one has really done any research as such into the possibility. PMR/GCA is not a life or death type illness, so may not attract the interest??

[Miacaro45 in reply to piglette]

You are quite correct. Thanks

[PMRpro Ambassador in reply to piglette]

There is a study which has established that the incidence of a/f is greater in a few rheumatological disorders - including RA and PMR ...

ncbi.nlm.nih.gov/pmc/articl...

Vasculitis is greater than PMR - which will include GCA.

[montebello]

Although a direct link between vascular and cardiomyopathy might not be obvious, isn't there a direct link between long term prednisone usage and cardiomyopathy?

[PMRpro Ambassador in reply to montebello]

Not yet properly proven - there are suggestions and isolated case reports, mostly Japanese with several authors and published in online journals, which usually means it was a "write a paper for your CV". Correlation is not causation and usually it resolves on stopping pred.

[montebello in reply to PMRpro]

Thanks for this, Pro!

[papadapadoo]

Since coming down with PMR and commencing prednisone 18 months ago, I have been diagnosed with afib. Of course, I may have had afib before, as I have never felt any symptoms.

[PMRpro Ambassador in reply to papadapadoo]

I, too, have PMR and a/fib - caused by the autoimmune part of the PMR damaging the electrical cells in the sinus node. The cardiac symptoms appeared about the same time as the PMR symptoms, long before pred, but weren't recognised. Not always pred to blame!

[perceptual63]

One of my rheumatologists mentioned to me that prednisone itself can cause heart issues.

[PMRpro Ambassador in reply to perceptual63]

It can - but sometimes it is blamed when not guilty. I, too, have PMR and a/fib - caused by the autoimmune part of the PMR damaging the electrical cells in the sinus node. The cardiac symptoms appeared about the same time as the PMR symptoms, long before pred, but weren't recognised. But the obvious culprit would have been pred since there was no evidence from the pre-pred period. However, after the a/fib was identified and treated I recognised that the episodes that had been quite puzzling were gone.

[perceptual63 in reply to PMRpro]

I'm glad that your a/fib was recognized and treated and hope you are doing well with treatment..

I have had a wide QRS (now 160) for almost a decade before prednisone was ever introduced so (thankfully?) it's not prednisone that caused it.

[PMRpro Ambassador in reply to perceptual63]

I've had an ablation now - cured!!!!