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Toshniwal S, Sahai I, Ghosh B, Chaturvedi A, Agrawal G, Acharya S, Kumar S, Khadse S, Khurana K. Case Report: Multiple atherosclerotic plaques at its extreme in synchrony. F1000Res 2024; 12:738. [PMID: 38434660 PMCID: PMC10905029 DOI: 10.12688/f1000research.135416.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/05/2024] Open
Abstract
Peripheral artery (PAD) disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral artery disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.
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Affiliation(s)
- Saket Toshniwal
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Isha Sahai
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Benumadhab Ghosh
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Anuj Chaturvedi
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Gajendra Agrawal
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Sourya Acharya
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Sunil Kumar
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Satish Khadse
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Kashish Khurana
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
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Toshniwal S, Sahai I, Ghosh B, Chaturvedi A, Agrawal G, Acharya S, Kumar S, Khadse S, Khurana K. Case Report: Multiple atherosclerotic plaques at its extreme in synchrony. F1000Res 2024; 12:738. [PMID: 38434660 PMCID: PMC10905029 DOI: 10.12688/f1000research.135416.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 04/13/2024] Open
Abstract
Peripheral artery (PAD) disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral artery disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.
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Affiliation(s)
- Saket Toshniwal
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Isha Sahai
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Benumadhab Ghosh
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Anuj Chaturvedi
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Gajendra Agrawal
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Sourya Acharya
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Sunil Kumar
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Satish Khadse
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Kashish Khurana
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
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Abstract
Diagnosing renal artery stenosis can be difficult. This article explores possible types of imaging for this, ranging from safe, inexpensive tests to more invasive procedures
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Affiliation(s)
- L A Ratnam
- Radiology Department, St George's Hospital, London SW17 0QT
| | - S R Nelson
- Radiology Department, St George's Hospital, London SW17 0QT
| | - A M Belli
- Radiology Department, St George's Hospital, London SW17 0QT
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de Silva R, Nikitin NP, Bhandari S, Nicholson A, Clark AL, Cleland JGF. Atherosclerotic renovascular disease in chronic heart failure: should we intervene? Eur Heart J 2005; 26:1596-605. [PMID: 15919719 DOI: 10.1093/eurheartj/ehi304] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Renal artery stenosis (RAS) is most commonly caused by atherosclerosis, which is also the most common cause of chronic heart failure (CHF). One-third of patients with CHF are reported to have significant renovascular disease. The presence of RAS confers a worse outcome in studies of hypertension and coronary disease, though data are lacking for patients with CHF. As the kidney is intricately involved in the fluid retention that occurs in CHF, an adverse effect of RAS on outcome would be expected. Presentations of RAS in CHF include flash pulmonary oedema, hypertension, worsening of CHF, and worsening renal function. RAS commonly progresses and may cause worsening of renal function in patients with CHF and previously stable renal function. A variety of investigations that can safely and accurately identify RAS in CHF are available, although none is recommended in current guidelines for the management of CHF. Treatment for RAS, whether for hypertension, for renal dysfunction, or for pulmonary oedema, is at the discretion of the physician due to the lack of adequate randomized controlled trials demonstrating the efficacy and safety of intervention. As it is not clear how RAS should be managed in CHF, screening cannot be advocated. Currently, a multicentre randomized outcome trial, which includes a cohort of patients with RAS and CHF, is in progress to provide answers in this area of uncertainty.
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Affiliation(s)
- Ramesh de Silva
- Academic Cardiology, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, UK.
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Bolad IA, Breen J, Rogers P, Partridge J, Banner NR. Prevalence and significance of renal artery stenosis and abdominal aortic atherosclerosis early after heart transplantation. Transplant Proc 2002; 34:3236-8. [PMID: 12493431 DOI: 10.1016/s0041-1345(02)03695-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- I A Bolad
- Transplant Unit, Harefield Hospital, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex, UK
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