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[Coronary aneurysm in a 69-year-old patient. Transthoracic echocardiography]
N Watzinger1, F M Fruhwald, I Schafhalter
1Abteilung für Kardiologie, Medizinische Universitätsklinik Graz.
Insights
A 69-year-old male with suspected Lyme borreliosis developed a large coronary artery aneurysm. Despite coronary three-vessel disease, conservative management was recommended due to mild symptoms.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Medicine
Background:
- Lyme borreliosis can present with cardiac manifestations, including myocarditis.
- Coronary artery aneurysms are rare but serious vascular complications.
Observation:
- A 69-year-old male with suspected Lyme borreliosis presented with a large proximal left coronary artery aneurysm (1.2 cm).
- Transthoracic echocardiography and coronary angiography confirmed the aneurysm and revealed three-vessel coronary artery disease with reduced left ventricular function.
Findings:
- The patient was largely asymptomatic despite significant coronary artery disease and aneurysm.
- Coronaritis secondary to Lyme borreliosis was suspected but not definitively confirmed.
Implications:
- This case highlights the potential for Lyme borreliosis to cause coronary artery aneurysms.
- It underscores the importance of considering infectious etiologies in coronary aneurysms.
- Conservative management may be appropriate for asymptomatic patients with coronary aneurysms and significant comorbidities.
Abstract:
This case report is on a 69-year old male patient treated with cephalosporins because of suspected myocarditis due to borreliosis. Using transthoracic echocardiography a big aneurysm of the proximal part of the left coronary artery was detected. Coronary angiography revealed an aneurysm 1.2 cm in diameter at the origin of the left anterior descending branch and confirmed the initial diagnosis. In addition, coronary three-vessel disease with reduced left ventricular function was found. Coronaritis due to Lyme borreliosis could not be ruled out with certainty. The patient was relatively asymptomatic, and hence conservative therapy was recommended. The case described here serves as a basis for a discussion on the aetiology, clinical manifestation, diagnosis and therapeutic management of coronary aneurysms.