Coronary artery ectasia presenting with acute inferior wall myocardial infarction in a young adult

Latt, Htun; Aung, Sammy San Myint; Kyaw, Kyaw; Seher, Richard

doi:10.1080/20009666.2017.1369376

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…In patients with isolated CAE, anticoagulant therapy alone may be appropriate due to turbulence and stasis of blood in the ectatic vessel [6]. A search of existing literature that reported cases of patients with recurrent ACS in CAE showed that there were two isolated cases of CAE in which the patient took DAPT without an anticoagulant and experienced recurrence [10–18]. To the best of our knowledge, there has not been a report of recurrent ACS after anticoagulation that has met the target of treatment, and there has not been a report of recurrent ACS after treatment with DAPT in a nonisolated case.…”

Section: Discussionmentioning

confidence: 99%

Recurrent acute coronary syndrome in a patient with right coronary artery ectasia: a case report

2019

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Background Coronary artery ectasia is characterized by an abnormal dilatation of the coronary arteries. Coronary artery ectasia is observed in 3–8% of patients undergoing coronary angiography and sometimes leads to acute coronary syndrome regardless of the presence or absence of coronary stenosis or atrial fibrillation. Case presentation A 61-year-old Indonesian man presented with typical angina that began 1 week before admission and had worsened 3 hours prior to admission. Accompanying symptoms included dyspnea, nausea, and sweating. He was hemodynamically stable and had a history of tobacco smoking and dyslipidemia. An electrocardiogram showed ST-segment depression and T inversion. Laboratory results showed an international normalized ratio of 1.28. Dual antiplatelet therapy was administered along with fondaparinux, and symptoms were alleviated. Coronary angiography showed an ectatic and turbulent mid-distal right coronary artery and slow flow at the first presentation. There was a patent stent in the proximal-mid left anterior descending coronary artery. This patient had previously presented with recurrent acute coronary syndrome and received two coronary stents for the stenotic vessels. Discussion He had right coronary artery ectasia and experienced recurrent acute coronary syndrome. He received dual antiplatelet therapy along with warfarin after stenting of his left anterior descending coronary artery. However, he presented with unstable angina pectoris 7 months before the latest admission and at the latest admission despite a patent stent and no other significant obstructive lesion. The unstable angina pectoris might have been caused by slow flow, microvascular angina caused by small thrombi and/or vasospasm, or epicardial thrombosis at the ectatic coronary artery that dissolved after anticoagulation therapy prior to coronary angiography. Anticoagulant therapy may have a greater benefit than antiplatelet therapy in this patient due to the turbulence and stasis of blood in the ectatic vessel, although coexisting coronary conditions mandated antiplatelet therapy. His international normalized ratio was suboptimal and needed to be improved. Conclusion Coronary ectasia may play a role in recurrent acute coronary syndrome, and administration of an anticoagulant to prevent acute coronary syndrome in this patient was in accordance with the varying hemodynamic property of coronary artery ectasia.

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Section: Discussionmentioning

confidence: 99%

Recurrent acute coronary syndrome in a patient with right coronary artery ectasia: a case report

2019

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“…Local thrombosis, distant embolization, or aneurysmal rupture can contribute to ACS and result in severe complications. Although atherosclerosis is thought to be the main contributing factor to CAAs, several cases have reported that local CAA thrombosis can result in acute myocardial infarction (MI) even without any significant past cardiovascular history [ 15 - 17 ]. One proposed explanation for the presence of anginal symptoms without obstructive lesions in CAA patients is coronary slow flow (CSF).…”

Section: Acute Coronary Syndrome Secondary To Coronary Artery Aneurysmsmentioning

confidence: 99%

Coronary Artery Aneurysms as a Cause of Acute Coronary Syndrome Presentation - A Focused Review

Latif

Tran

Ahsan

et al. 2023

CCR

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Coronary artery aneurysms (CAA) are defined as a dilation of a coronary vessel greater than 1.5 times the diameter of a local reference vessel. While CAAs tend to be incidental findings on imaging, they result in complications, such as thrombosis, embolization, ischemia, arrhythmias, and heart failure. Among symptomatic cases, chest pain has been the most common manifestation of CAAs. This necessitates an understanding of CAAs as a cause of acute coronary syndrome (ACS) presentation. However, due to the unclear pathophysiology of CAAs and their variable presentation complicated by similar ACS conditions, there is no clear strategy for CAA management. In this article, we will discuss the contribution of CAAs to ACS presentations and review the current management options for CAAs.

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“…We collected 13 cases from 11 reports. 1,2,[9][10][11][12][13][14][15][16] Ten patients (76.9%) were male, and three (23.1%) were female. Mean age was 54.92 AE 4.17 years.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports

et al. 2019

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Coronary artery ectasia is found in 3 to 8% of patient's undergoing angiography and may sometimes induce acute myocardial infarction. Some articles reported a recurrence of acute coronary syndrome (ACS) in the presence of coronary artery ectasia (CAE). Our study aims to summarize the latest evidence on whether the use of anticoagulant in addition to SAPT/DAPT (single antiplatelet/dual antiplatelet) treating ACS with CAE patients is necessary. Since the trials concerning our objectives were scarce, we pooled case reports/series. We performed a comprehensive search on case reports/series on coronary artery ectasia that presented with acute coronary syndrome published until March 2019. We collected 13 cases from 11 reports. Out of 13 patients, 5 (38.5%) took DAPT only without anticoagulant and 8 (61.5%) took anticoagulant ± DAPT. Three out of five (60%) who took DAPT only, experienced recurrences at 1st and 2nd months' follow-up. The other two (40%) was uneventful at a mean of two months' follow-up. Eight patients who took anticoagulant were uneventful for a mean of 8.4 months. Those who took anticoagulant were at lower risk of experiencing ACS recurrence (p = 0.035). Two of the patients who experienced recurrence became 6 and 12 months free after optimal anticoagulation. The author of this study proposed that anticoagulant must be considered should SAPT/DAPT failed to provide adequate protection to the recurrence of ACS, especially in CAE patients who did not have other obvious stenotic lesions. However, the evidence is weak since this study only pooled case reports/series.

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Coronary artery ectasia presenting with acute inferior wall myocardial infarction in a young adult

Cited by 5 publications

References 14 publications

Recurrent acute coronary syndrome in a patient with right coronary artery ectasia: a case report

Recurrent acute coronary syndrome in a patient with right coronary artery ectasia: a case report

Coronary Artery Aneurysms as a Cause of Acute Coronary Syndrome Presentation - A Focused Review

Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports

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