Giant cell arteritis is frequently an attendant complication of polymyalgia rheumatica. While involvement of other arterial beds is occasionally identified, this syndrome is most frequently recognized when symptomatic involvement of the temporal arteries occurs. We describe such a patient who despite initial treatment with high-dose intravenous and standard (5-day) orally administered corticosteroid therapy suffered a fatal myocardial infarction, which at autopsy was shown to be a consequence of granulomatous coronary arteritis. The literature is reviewed and the clinical implications of this case are discussed.