Growing pains—and a heart attack

Magnetic resonance angiography (MRA) also showed the occlusions, as well as thickening of the wall of the ascending aorta. Many young patients have systemic symptoms, such as fatigue, night sweats, fever, poor appetite, weight loss, and joint pain.1 Cardiac features are present in around 40% of all patients, and can include aortic regurgitation, pericarditis, congestive cardiac failure, and palpitations.2 Hypertension is present in up to 72% of patients, and is usually caused by renal artery disease.3 Surprisingly, angina is a presenting feature in less than 16% of cases.2 Major complications, such as myocardial infarction, stroke, heart failure, or arterial aneurysms, occur in 50% of patients.2 Angiography is commonly the first investigation.