Multiple coronary aneurysms in a young adult with acquired immunodeficiency syndrome

Abstract

HIV infection can cause multiple deleterious effects on the cardiovascular system. Emerging evidence has supported a direct association between HIV infection and accelerated atherosclerosis. The mechanism for atherosclerosis in HIV-positive patients is multifactorial, an interplay between conventional risk factors, HIV itself and highly active antiretroviral therapy. The case described is a 29-year-old man with HIV, non-adherent to antiretroviral therapy and with few cardiovascular risk factors, who presented with chest pain and non-ST elevation myocardial infarction. Cardiac catheterization revealed multiple coronary artery aneurysms in the left main coronary artery and the right coronary artery. Aneurysmal formation may develop from vasculitis, HIV itself, accelerated atherosclerosis, congenital formation or medications (e.g. protease inhibitors). The researchers provide a review of coronary artery disease, aneurysmal formation and vasculitic processes in the context of HIV. As this clinical entity becomes more apparent, alternative therapeutic options may need to be explored.

Spectrum of Coronary Artery Aneurysms:From the Radiologic Pathology Archives

“…It is now well recognized that mycotic CAAs are frequently associated with sepsis, bacteremia, or endocarditis (160,161). Bacterial agents are reported to be the most common cause of mycotic CAAs, but mycotic CAAs are also found in patients with human immunodeficiency syndrome, syphilis, viral infection (Epstein-Barr virus), or fungal infection (162)(163)(164). More recently, mycotic CAAs have occurred after percutaneous coronary interventions (164,165).…”

Coronary artery aneurysm, ectasia and stenosis in a 53-year-old man with HIV infection

“…Infection by HIV also results in diffuse endothelial dysfunction affecting multiple organ systems including the coronary arteries [ 10 ]. Although less is known about the association between HIV and coronary aneurysms, extra-cranial arterial aneurysms in the context of HIV have been well-described [ 11 ], and coronary artery aneurysms have been reported in patients with acquired immunodeficiency syndrome [ 12 , 13 ] and other vasculitides [ 14 , 15 ]. We report what we believe to be the first described case of both coronary stenosis and coronary artery aneurysms in a person living with HIV.…”

Outcome of a giant coronary artery mycotic pseudoaneurysm secondary to non-typhoidSalmonellamanaged without surgical intervention

“…HIV is an independent risk factor for coronary artery pseudoaneurysms 9. The mechanisms of development in HIV patients include HIV vasculitis, accelerated atherosclerosis, congenital and protease inhibitor use 9. Although our patient had a 10-year history of HIV with evidence of non-compliance with antiviral therapy, she did not have a coronary artery pseudoaneurysm at the time of her coronary artery bypass graft procedure 6 months prior.…”

“…HIV is an independent risk factor for coronary artery pseudoaneurysms 9. The mechanisms of development in HIV patients include HIV vasculitis, accelerated atherosclerosis, congenital and protease inhibitor use 9.…”