ST-elevation myocardial infarction complicated by ventricular tachycardia revealing coronary artery ectasia: a case
Imane Tlohi1, Fatiha Karim2, Asmaa Elamraoui2
1Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco. imane.tlohi@gmail.com.
Insights
Coronary artery ectasia, a rare condition, can complicate ST-elevation myocardial infarction, increasing risks. Optimal treatment for these ecstatic vessels remains uncertain, posing challenges in patient management.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary artery ectasia (CAE) is a rare angiographic finding affecting 0.3-5% of patients undergoing coronary angiography.
- CAE compromises vessel wall integrity and is linked to increased cardiovascular events and mortality in ST-elevation myocardial infarction (STEMI) patients post-percutaneous coronary intervention.
- This case highlights CAE in the context of acute myocardial infarction.
Background:
Coronary artery ectasia is a rare angiographic finding and results from a disease process that compromises the integrity of the vessel wall. Its prevalence ranges between 0.3% and 5% of patients undergoing coronary angiography (Swaye et al. in Circulation 67:134-138, 1983). Coronary artery ectasia in patients with ST-elevation myocardial infarction is associated with an increased risk of cardiovascular events and death after percutaneous coronary intervention.
Case Presentation:
We report the case of a 50-year-old male Caucasian patient, admitted for ventricular tachycardia at 200 beats per minute hemodynamically not tolerated that was reduced by external electric shock. Electrocardiogram after cardioversion showed a sinus rhythm with anterior ST-elevation myocardial infarction. Thrombolytic therapy was chosen after exposure to dual antiplatelet therapy and heparin since the expected time to percutaneous coronary intervention was greater than 120 minutes from first medical contact and the patient presented within 12 hours of onset of ischemic symptoms. The electrocardiogram after thrombolysis showed the resolution of the ST segment. The echocardiogram showed a dilated left ventricle with severe dysfunction with left ventricle ejection fraction at 30%. Coronary angiography revealed non-obstructive giant ecstatic coronaries without any thrombus. A check-up to look for possible etiologies for coronary artery ectasia was carried out and returned normal. Since no etiology for coronary artery ectasia was found at the limit of available exams in our center, the patient was discharged with antiplatelet therapy (aspirin 100 mg once a day) and heart failure treatment with an indication for an implantable cardiac defibrillator.
Conclusions:
Coronary artery ectasia in the context of acute myocardial infarction is a rare condition that may have dangerous complications, especially when an optimal treatment for ecstatic culprit vessels is still controversial.
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