Related Experiment Videos
Unusual presentation of an acute inferior myocardial infarction
Kavita Kumar1, Norman E Lepor, Tasneem Z Naqvi
1Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Insights
Coronary artery aneurysms and pseudoaneurysms are rare but serious conditions. Prompt diagnosis and treatment are crucial for patients presenting with myocardial infarction or suspected connective tissue disorders.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Coronary artery aneurysms affect approximately 1.5% of patients.
- Pseudoaneurysms of native coronary arteries are poorly documented.
- These conditions can lead to severe complications including myocardial infarction and rupture.
Purpose of the Study:
- To review the presentation, complications, and treatment of coronary artery aneurysms and pseudoaneurysms.
- To emphasize the importance of clinical suspicion in diagnosis.
Main Methods:
- Literature review of existing reports on coronary artery aneurysms and pseudoaneurysms.
- Analysis of clinical presentations, diagnostic findings, and treatment modalities.
Main Results:
- Patients present with diverse symptoms, from asymptomatic to sudden death.
- Complications include angina, myocardial infarction, fistula, rupture, and distal embolization.
- Diagnostic imaging may reveal masses; high clinical suspicion is key.
Conclusions:
- Coronary anomalies and nonatherosclerotic diseases should be considered in young patients with myocardial infarction.
- Connective tissue disorders are associated with coronary aneurysms/pseudoaneurysms.
- Treatment involves surgical ligation with bypass or covered stent implantation.
Abstract:
There is a paucity of data on pseudoaneurysms of native coronary arteries; however, several reports exist on coronary artery aneurysms, which occur in approximately 1.5% of patients studied at autopsy or during cardiac catheterization. Patients can present with a wide range of symptoms from asymptomatic to sudden death. Complications include angina, myocardial infarction, fistula formation, spontaneous rupture, and distal embolization as a result of thrombus formation within the aneurysm. Treatment options include surgical ligation with coronary artery bypass surgery and implantation of a covered stent. Coronary anomalies and nonatherosclerotic coronary artery diseases should be suspected when a young patient presents with a myocardial infarction. Additionally, coronary aneurysm or pseudoaneurysm should be considered in patients with connective tissue disorder or the suggestion of connective tissue disorder. These entities may present as masses radiographically or echocardiographically. A high clinical suspicion is required for appropriate diagnosis and treatment.