SHM Converge Scientific Abstract ePoster Gallery-Kawasaki Consequence

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A 32-year-old South Asian man with hyperlipidemia presented to the ED with severe, crushing substernal chest pain accompanied by nausea and diaphoresis that woke him from sleep. He appeared uncomfortable on exam, though cardiac and pulmonary examinations were otherwise normal. Initial troponin I was elevated at 1.159 ng/mL and rose rapidly to 40 ng/mL over serial testing. EKG showed normal sinus rhythm with Q waves in leads III and aVF, later progressing to bradycardia with a new junctional escape rhythm.<br /><br />Cardiac catheterization revealed aneurysmal changes in all coronary arteries and an acute 100% thrombotic occlusion of the proximal right coronary artery. He underwent aspiration thrombectomy and drug-eluting stent placement with restoration of RCA flow. Further history uncovered a childhood hospitalization for febrile illness at age 5, after which he had been diagnosed with cardiac sequelae of Kawasaki disease.<br /><br />This case highlights Kawasaki disease as an important cause of acute coronary syndrome in young adults. Coronary artery aneurysms occur in about 20–25% of Kawasaki patients and can predispose to atherosclerosis, calcification, and thrombus formation, leading to STEMI. Management of acute events may include thrombectomy and stenting, while coronary artery bypass is considered definitive treatment for Kawasaki-related aneurysmal coronary disease. Aggressive cardiovascular risk factor control is also recommended.

Asset Subtitle

Keon Pearson

Meta Tag

Author List Julia A. Armendariz, Keon Pearson

Category Clinical Vignettes

Concept Acute Coronary Syndrome

Concept Kawasaki Disease

Concept STEMI

Concept Coronary Artery Aneurysm

Concept Stable Ischemic Heart Disease

Distinguished Non-Finalist

Presenter Organization Stanford Health Care

Presenting Author Keon Pearson

Track Adult

Keywords

Kawasaki disease

acute coronary syndrome

coronary artery aneurysm

myocardial infarction

right coronary artery occlusion

thrombotic occlusion

drug-eluting stent

aspiration thrombectomy

troponin elevation

young adult chest pain

Acute Coronary Syndrome

Kawasaki Disease

STEMI

Coronary Artery Aneurysm

Stable Ischemic Heart Disease