SHM Converge Scientific Abstract ePoster Gallery-Rare Case of Sequential Coronary Aneurysms Leading to Myocardial Infarction

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This case report describes an extremely rare presentation of sequential giant coronary artery aneurysms causing cardiogenic shock and myocardial infarction. Coronary artery aneurysms are uncommon, occurring in only 0.3% to 5% of patients undergoing coronary angiography, and giant aneurysms are even rarer. Most are associated with atherosclerosis, though Kawasaki disease, vasculitis, congenital abnormalities, connective tissue disorders, and iatrogenic injury are also recognized causes.<br /><br />The patient was a 70-year-old woman with chronic kidney disease stage IV, Crohn’s disease status post right colectomy, and other medical issues who presented with two weeks of nausea, anorexia, dehydration, fever, chills, weakness, flank pain, and back pain. She was found to be in shock, with concern for septic versus cardiogenic shock. Laboratory testing showed elevated BNP and persistently elevated troponin I. Echocardiography revealed a severely reduced ejection fraction of 25%–30%, akinetic apical and basal segments, mild mitral and tricuspid regurgitation, and an echo-lucent structure in a right-sided pericardial effusion.<br /><br />Initially, her ECG was not strongly diagnostic, and she was treated as having NSTEMI. The next day, she developed significant ST elevations in the inferior and posterior leads, indicating an evolving infarction. Coronary angiography then demonstrated two large sequential aneurysms in the mid-right coronary artery, each approximately 4 x 5 cm, with moderate stenosis between them. There was also about 40% narrowing in the mid-LAD.<br /><br />The authors believe the aneurysms were likely due to atherosclerosis, possibly with an unrecognized vasculitic component. Management options for CAA include medical therapy, percutaneous intervention, or surgery, but the optimal treatment for this unusual anatomy is unclear. The patient required transfer for more advanced care and died shortly afterward.

Asset Subtitle

Alexander Cuevas

Meta Tag

Author List Alberth Alvarado, Alexander Cuevas, Isabella Chojnacki, Theodora Balaj

Category Clinical Vignettes

Concept Coronary Artery Aneurysm

Concept Giant Coronary Artery Aneurysm

Concept Coronary Angiography

Concept Etiology

Concept Pathophysiology

Distinguished Non-Finalist

Presenter Organization Ascension Genesys Internal Medicine

Presenting Author Alexander Cuevas

Track Adult

Keywords

coronary artery aneurysm

giant coronary aneurysm

cardiogenic shock

myocardial infarction

NSTEMI

right coronary artery

coronary angiography

atherosclerosis

echocardiography

sequential aneurysms

Coronary Artery Aneurysm

Giant Coronary Artery Aneurysm

Coronary Angiography

Etiology

Pathophysiology