Case history
Case history #1
A 28-year-old woman presents with new left-arm pain. She was previously well but for 2 months has had episodes of low-grade fever, night sweats, and arthralgia. She works as a shop assistant and has noticed left-arm pain when she stocks shelves. Her only medication is an oral contraceptive. She does not smoke cigarettes. On examination, her blood pressure is 126/72 mmHg in her right arm, but it cannot be measured in her left arm. The left radial pulse cannot be detected. There is a bruit over the left subclavian artery. Carotid pulses are normal but there is a bruit over the right carotid artery. Femoral and pedal pulses are normal and no abdominal bruits are heard. The left hand is cool but has no other evidence of ischaemia.
Case history #2
A 39-year-old woman presents with headaches of insidious onset over 3 months. She has lost 3 kilograms during this time but feels otherwise well. On examination, bilateral blood pressures taken in the arms are 190/110 mmHg on the right and 200/110 mmHg on the left. She is taking a multivitamin but no other medications. For the past 20 years she has smoked 10 cigarettes a day. Urinalysis reveals an estimated protein of 360 mg/24 hour.
Other presentations
Non-specific constitutional symptoms, including fever, weight loss, and fatigue, are common.[1][4][7] Patients may also present with an absent pulse or immeasurable blood pressure in 1 extremity.[8] New-onset hypertension or aortic regurgitation may be present. Coronary artery involvement can lead to angina pectoris, but pericarditis and congestive heart failure are uncommon presentations. Pulmonary artery involvement may result in chest pain, dyspnoea, or haemoptysis. Involvement of cranial arteries can present as a headache, transient ischaemic attack, or stroke. Visual symptoms may include blurring, scotoma, diplopia, and amaurosis fugax. The retinal arteriovenous anastomoses described by Takayasu are rare.[9] Mesenteric artery involvement can cause abdominal pain or gastrointestinal haemorrhage. Vascular bruits are often found on auscultation.[7][8] Erythema nodosum is occasionally noted.[10]
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