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Case report
peer-reviewed

Coronary Artery Aneurysm Presenting as Non-ST Elevation Myocardial Infarction



Abstract

Coronary artery aneurysms are rare in the general population. There are no randomized control trials to guide the therapy at this moment. We present a case of a 52-year-old male who was recovering from addiction and was sober for past five years. He came to the hospital with typical chest pain. There were ST segment depressions in leads III and AVF. The second troponin was found to be elevated. The impression was non-ST-segment elevation myocardial infarction. He was started on subcutaneous enoxaparin and underwent left heart catheterization which revealed dilated ectatic coronary arteries with aneurysmal dilatation. In addition, there was sluggish blood flow and several blood clots mainly in the left circumflex artery. No intervention was performed and the patient was started on heparin drip which was transitioned to warfarin on discharge. The echocardiogram revealed an ejection fraction of 35% with anterior and inferoseptal wall dyskinesia. Echocardiogram at one-year follow-up showed improved ejection fraction of 50% with similar wall dyskinesia. Coronary artery aneurysms are treated with medical management with or without invasive approach. Invasive management is conducted in people with stenosis and can be achieved by coronary artery bypass graft or covered stents. 



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Case report
peer-reviewed

Coronary Artery Aneurysm Presenting as Non-ST Elevation Myocardial Infarction


Author Information

Murtaza Sundhu Corresponding Author

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Mehmet Yildiz

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Bilal Saqi

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Bilal Alam

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Sidra Khalid

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Emad Nukta

Cardiology, Fairview Hospital, Cleveland Clinic, USA


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Coronary Artery Aneurysm Presenting as Non-ST Elevation Myocardial Infarction


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Case report
peer-reviewed

Coronary Artery Aneurysm Presenting as Non-ST Elevation Myocardial Infarction

  • Author Information
    Murtaza Sundhu Corresponding Author

    Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

    Mehmet Yildiz

    Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

    Bilal Saqi

    Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

    Bilal Alam

    Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

    Sidra Khalid

    Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

    Emad Nukta

    Cardiology, Fairview Hospital, Cleveland Clinic, USA


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: July 06, 2017

    DOI

    10.7759/cureus.1436

    Cite this article as:

    Sundhu M, Yildiz M, Saqi B, et al. (July 06, 2017) Coronary Artery Aneurysm Presenting as Non-ST Elevation Myocardial Infarction. Cureus 9(7): e1436. doi:10.7759/cureus.1436

    Publication history

    Received by Cureus: May 26, 2017
    Peer review began: June 05, 2017
    Peer review concluded: June 27, 2017
    Published: July 06, 2017

    Copyright

    © Copyright 2017
    Sundhu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Coronary artery aneurysms are rare in the general population. There are no randomized control trials to guide the therapy at this moment. We present a case of a 52-year-old male who was recovering from addiction and was sober for past five years. He came to the hospital with typical chest pain. There were ST segment depressions in leads III and AVF. The second troponin was found to be elevated. The impression was non-ST-segment elevation myocardial infarction. He was started on subcutaneous enoxaparin and underwent left heart catheterization which revealed dilated ectatic coronary arteries with aneurysmal dilatation. In addition, there was sluggish blood flow and several blood clots mainly in the left circumflex artery. No intervention was performed and the patient was started on heparin drip which was transitioned to warfarin on discharge. The echocardiogram revealed an ejection fraction of 35% with anterior and inferoseptal wall dyskinesia. Echocardiogram at one-year follow-up showed improved ejection fraction of 50% with similar wall dyskinesia. Coronary artery aneurysms are treated with medical management with or without invasive approach. Invasive management is conducted in people with stenosis and can be achieved by coronary artery bypass graft or covered stents. 



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Murtaza Sundhu, M.D.

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

For correspondence:
murtaza89ali@gmail.com

Mehmet Yildiz

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Bilal Saqi

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Bilal Alam

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Sidra Khalid

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Emad Nukta

Cardiology, Fairview Hospital, Cleveland Clinic, USA

Murtaza Sundhu, M.D.

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

For correspondence:
murtaza89ali@gmail.com

Mehmet Yildiz

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Bilal Saqi

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Bilal Alam

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Sidra Khalid

Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA

Emad Nukta

Cardiology, Fairview Hospital, Cleveland Clinic, USA