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Coronary artery aneurysms: the chest pain "zebra"

Zoe J Clifford1, Philippa Jt Bowers2, Graham D McCrystal3

  • 1Non-training Surgical Registrar, Cardiothoracic Surgery, Christchurch Public Hospital, Christchurch, New Zealand.

The New Zealand Medical Journal
|October 19, 2023
PubMed

Insights

Coronary artery aneurysms (CAAs) are rare vascular dilatations. This case highlights a patient with CAA, ST elevation myocardial infarction, and end-stage renal failure, discussing treatment options for this complex presentation.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Nephrology

Background:

  • Coronary artery aneurysms (CAAs) are defined as dilatations exceeding 1.5 times the adjacent normal vessel diameter.
  • CAAs can manifest with diverse symptoms, including chest pain, electrocardiogram (ECG) changes, mass effects, or life-threatening rupture with cardiac tamponade.

Observation:

  • This report details a rare clinical scenario involving a patient with ST elevation myocardial infarction (STEMI).
  • The patient also presented with concurrent end-stage renal failure, complicating the clinical picture.

Findings:

  • The case underscores the diagnostic and therapeutic challenges posed by co-existing coronary artery aneurysms and acute myocardial infarction in patients with severe renal impairment.
  • Management strategies for this rare combination require careful consideration of cardiovascular and renal comorbidities.

Implications:

  • This case highlights the importance of considering rare etiologies like CAAs in patients with myocardial infarction, especially those with significant comorbidities.
  • Optimal treatment strategies for such complex cases may involve a multidisciplinary approach, balancing risks and benefits of revascularization and medical management.
  • Further research into the management of coronary artery aneurysms in the context of renal failure is warranted to improve patient outcomes.

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