Abstract
BACKGROUND: Vasculitis and aortitis can contribute to early coronary artery stenosis, causing ischemic cardiomyopathy. CASE SUMMARY: A 45-year-old woman with recently diagnosed heart failure and no known cardiac risk factors was found to have multivessel coronary artery disease on elective angiography, prompting coronary bypass surgery, during which her aorta appeared severely inflamed with circumferential thickening, although the stenosed coronaries had no signs of atherosclerosis, and histologic examination indicated aortitis secondary to IgG4-related disease as the driver of her ischemic cardiomyopathy. DISCUSSION: IgG4-related disease manifests in a variety of organs and tissues and is a well-known cause of aortitis with potential coronary involvement, often requiring histologic evaluation for diagnosis and management. TAKE-HOME MESSAGES: Aortitis can contribute to stenosis within the proximal coronaries either via extension of the vasculitis or external compression from the aorta. In cases of aortitis and early coronary disease, IgG4-related disease and vasculitis should be considered.