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Giant Coronary Artery Aneurysms Presenting As Posterior Myocardial Infarction

Syed M Ishaq1, Sanchit Duhan1, Bijeta Keisham2

  • 1Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA.

Cureus
|February 12, 2024
PubMed

Insights

Coronary artery aneurysms (CAAs) are vessel dilatations that can mimic acute coronary syndromes. Medical management, including beta-blockers, statins, and anticoagulation, proved effective for a patient with multiple CAAs and pulmonary hypertension.

Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Coronary artery aneurysm (CAA) is defined as a vessel dilatation ≥1.5 times the adjacent normal diameter.
  • Giant CAAs lack a universally accepted definition, highlighting a gap in current classifications.

Observation:

  • A 45-year-old male presented with substernal chest pain, ECG changes (ST depression, T wave inversions), but normal cardiac biomarkers.
  • Cardiac catheterization revealed CAAs in the right coronary artery (RCA), left anterior descending (LAD), and left circumflex (LCX) arteries.
  • The patient had severe pulmonary hypertension, posing a high risk for surgical intervention.

Findings:

  • Medical management with beta-blockers, high-intensity statin, and warfarin anticoagulation was initiated.
  • The patient remained asymptomatic at a two-month follow-up, indicating successful conservative treatment.

Implications:

  • Coronary artery aneurysms can manifest as acute coronary syndromes, necessitating prompt diagnosis.
  • Treatment strategies for CAAs are evolving, encompassing medical, percutaneous, and surgical options.
  • This case underscores the viability of medical management for selected CAA patients, particularly those with high surgical risk.

Keywords:
acute coronary syndromecoronary aneurysmcoronary artery ectasia (cea)giant coronary artery aneursymmyocardial infarction

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