990 IMMUNE-MEDIATED NECROTIZING MYOPATHY IN A PATIENT WITH MULTI-VESSEL CORONARY ARTERY DISEASE


 Inflammatory muscle diseases (often referred to as “inflammatory myopathies” or “myositis”) are a group of muscle diseases characterized by chronic muscle inflammation, inflammation of tissues associated with the muscles, muscle weakness and occasionally muscle pain (depending on the specific case).
 Ischemic heart disease is the leading cause of cardiovascular mortality in Western countries; the underlying cause is coronary atherosclerosis, a multifactorial disease determined by the concomitant presence of classic cardiovascular risk factors and inflammation of the vessel wall.
 We present the case of a 60 y/o man who previously underwent CABG (LIMA for ADA e GSV for OM1) for multi-vessel CAD and then developed immune-mediated necrotizing myopathy (probably due to statin treatment) with muscle weakness and pain and with elevation of myolysis markers: in this context, he also presented a recurrence of chest pain with troponin elevation, so that it was needed the integration of functional imaging from myocardial scintigraphy and from cardiac magnetic resonance to understand that troponin elevation (and the chest pain) were due to ischemia and not to muscle damage. This case report underlines how a critical approach to imaging and a deep knowledge of pathophysiology is mandatory in cardiovascular medicine.