A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia
| Autor: | Jaglan, Akshar, Ajam, Tarek, Port, Steven C, Bajwa, Tanvir, Tajik, A Jamil |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome Coronary angiography Population Case Reports 030204 cardiovascular system & hematology Chest pain 03 medical and health sciences 0302 clinical medicine Internal medicine Ectasia Case report medicine AcademicSubjects/MED00200 cardiovascular diseases education Cardiac Imaging (Echocardiography / Cardiac MRI / Nuclear Cardiology) education.field_of_study Ejection fraction business.industry Coronary artery ectasia Three-dimensional coronary imaging Coronary aneurysm medicine.disease Thrombosis Cardiology Kawasaki disease medicine.symptom Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | European Heart Journal: Case Reports |
| ISSN: | 2514-2119 |
| DOI: | 10.1093/ehjcr/ytaa274 |
| Popis: | Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy. |
| Databáze: | OpenAIRE |
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