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ABSTRACT
Coronary artery ectasia (CAE), a variant of coronary artery anomalies, is a rare clinical entity. Although atherosclerotic coronary artery disease (CAD) is the most common cause of acute coronary syndrome (ACS), CAE also conveys a relatively high risk for potentially life-threatening cardiac events. We report a case of a 35-year-old male with two-vessel CAE, who presented with acute inferior wall ST election myocardial infarction (STEMI). After initiating medical therapy including bivalirudin, emergent percutaneous coronary intervention (PCI) with stenting of postero-lateral branch of right coronary artery (RCA) was performed. Coronary angiography also showed diffuse ectasia of RCA and left anterior descending artery (LAD). The patient tolerated the procedure well and was discharged on appropriate medical therapy. He was followed-up at one month, with no resulting cardiac events. This case highlights the importance of CAE awareness. CAE has drawn the attention of clinicians because of its clinical implications, as well as its seemingly higher prevalence, due to the abundant use of coronary angiograms and advanced cardiac imaging in the contemporary world. Albeit there has been much progress in the understanding and management of the disease, questions still remain regarding the exact pathophysiology, management guidelines and prognosis of CAE, which are worth further study.
ARTICLE HISTORY
Received 7 January 2017
Accepted 10 August 2017
KEYWORDS
Coronary artery ectasia; coronary atherosclerosis; ST elevation myocardial infarction; percutaneous coronary intervention; stenting
1.Case presentation
A 35-year-old, healthy male presented with acute onset of severe left-sided chest pain, which started while he was exercising at the gym. This episode was associated with diaphoresis and nausea. He denied any personal history of similar complaints or known medical problems. He also denied a family history of sudden death or congenital heart disease. The pain was significantly relieved with aspirin, nitroglycerin and morphine. Vital signs were stable and physical exam was benign including cardiac exam. The initial electrocardiogram (EKG) was not significant; however, a repeat EKG about 4-hours later showed significant ST segment elevations in the inferior leads (Figure 1). Initial troponin was 0.04 ng/ml, which jumped to 97 ng/ml in about six hours. Emergent coronary angiogram was performed and revealed total occlusion at the ostium of the right posterolateral artery (RPLA) and mid-to-distal portion of right posterior descending artery (RPDA), with largely patent...