A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia
Akshar Jaglan1, Tarek Ajam1, Steven C Port1
1Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA.
Insights
Coronary artery ectasia (CAE) in a young woman presenting with acute coronary syndrome was managed conservatively. This rare condition, complicated by pregnancy, showed successful thrombus resolution and improved cardiac function.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Case Reports
Background:
- Coronary artery ectasia (CAE) is a rare vascular anomaly with varied etiologies, including Kawasaki disease and atherosclerosis.
- CAE can manifest at any age, posing diagnostic and management challenges.
Purpose of the Study:
- To report a unique case of managing multivessel CAE with aneurysmal changes in a young woman.
- To discuss the complexities of managing CAE presenting as acute coronary syndrome during pregnancy.
Main Methods:
- A 23-year-old woman presented with acute chest pain and elevated troponin levels.
- Coronary angiography revealed multivessel CAE with thrombus; conservative management with antiplatelet and anticoagulation therapy was initiated.
- Follow-up imaging confirmed thrombus resolution and improved cardiac function.
Main Results:
- Conservative management led to the resolution of coronary thrombi and improvement in apical dyskinesis.
- The patient's condition was complicated by an unadvised pregnancy, adding complexity to management.
Conclusions:
- Management of CAE, especially during acute coronary syndrome and pregnancy, is challenging due to limited data.
- Close patient surveillance is crucial for monitoring disease progression in CAE patients.
Background:
Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy.
Case Summary:
A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0-0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case.
Discussion:
Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.
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