Abstract We report a case of a 57-year-old woman with Takayasu arteritis. She had a long history of poorly controlled hypertension and now suffers from severe ischemic cardiomyopathy and lower limb claudication. She did not receive immunosuppressive treatment as there were no signs of inflammation clinically or biochemically. Inspite of the latter, her symptoms have progressed. This case highlights the importance of improved modes of detecting inflammation as well as the need for strict management of vascular risk factors to control atherosclerosis, which has an increased incidence in patients with Takayasu arteritis.