Simultaneous presence of a large coronary aneurysm and ectasia in a young patient with myocardial infarction--a case report

Coronary vasculitis with acute myocardial infarction in a young woman with systemic lupus erythematosus

Myocardial infarction in patients with systemic lupus erythematosus (SLE) is most commonly a consequence of atherosclerosis. Coronary vasculitis with aneurysms is a rare cause of myocardial ischemia in SLE. We present a case of a 22-year-old woman with a 4-year history of SLE who was admitted with acute onset of chest pain. Although initially treated for lupus pericarditis, she was subsequently found to have an acute myocardial infarction. Cardiac catheterization revealed multiple areas of aneurysmal coronary dilatation and only moderate stenoses of the secondary branches.In view of the angiographic findings, coronary revascularization was not indicated. Anticoagulant therapy was initiated as a result of the presence of large aneurysmal coronary dilatations, which are predisposed to in situ thrombosis and distal embolization. The coronary vasculitis was treated with immunosuppressive therapy. Measures aimed at secondary prevention of coronary artery disease, including optimization of lipid profile, blood pressure control, and prevention of left ventricular postinfarct remodeling, were initiated and continued indefinitely.

Predictors of exercise induced myocardial ischemia in patients with isolated coronary artery ectasia

The aim of this study was to investigate the angiographic predictors of exercise induced ischemia in patients with isolated coronary ectasia. We have prospectively analysed coronary angiograms of 1521 consecutive patients undergoing cardiac catheterisation. The overall incidence of coronary ectasia was 6.7% (102 patients). Forty-six patients (3%) with non-obstructive, diffuse or segmental coronary ectasia (i.e. isolated coronary ectasia) constituted the main study group. Coronary angiograms were reviewed for stigmata of an impaired coronary blood flow such as 'slow flow', 'segmental backflow phenomenon' and stasis. 'Slow flow' was quantified with frame counting. An ectasia-jeopardy score was also described in order to assess the effect of the extent of coronary ectasia on exercise induced ischemia. Exercise induced ischemia was observed in 24 patients (52%). Exercise test was abnormal in 70% of the patients with diffuse ectasia and 26% of patients with segmental ectasia (p = 0.003). The frame count of the arteries of the study group was higher than the control group but the correlation between the frame count of the ectatic vessels and exercise induced ischemia was not significant. Stasis of the dye also did not correlate with ischemia. There was a significant correlation between exercise induced ischemia and backflow phenomenon in left anterior descending artery (LAD) (r = 0.56, p = 0.0001). Exercise induced ischemia was best correlated with the ectasia-jeopardy score (r = 0.77, p = 0.0001) and a score of > or =4 identified the patients at risk with 90% sensitivity and 80% specificity. In conclusion, the extent of the ectasia within the coronary tree, diffuse ectasia and backflow-phenomenon in LAD were identified as the most important predictors of exercise induced ischemia.

Effect of trimetazidine on exercise performance in patients with coronary artery ectasia

Coronary artery ectasia (CAE) is a rare form of coronary artery disease. It has previously been shown that nitrate derivatives induce exertional angina in patients with CAE. Furthermore, there is limited data about the effects of other anti-ischemic agents in CAE. The aim of this study was to investigate the effect of trimetazidine on exercise performance in patients with CAE. The study population consisted of 56 patients with isolated CAE (32 males, mean age: 58 +/- 9 years). The presence of myocardial ischemia was evaluated by treadmill exercise test. The exercise test was positive in 49 patients at baseline and in 27 patients during trimetazidine therapy (P < 0.01). The exercise test induced angina in all of the patients who have had a positive test result. Significant ST depressions were observed in 42 and 23 patients before and after the treatment, respectively (P < 0.01). The extent of ST depression at peak exercise was significantly lower on trimetazidine (0.9 +/- 0.5 vs 1.5 +/- 0.6 mm, P < 0.01). With trimetazidine, the exercise duration increased from 7.8 +/- 2.1 to 8.7 +/- 2.4 min (P = 0.04) and cardiac work-load also increased from 8.9 +/- 2.3 to 10.4 +/- 2.1 mets (P < 0.01). The results suggest that trimetazidine can relieve exercise-induced angina and improve exercise performance in patients with CAE.

Nonatherosclerotic aneurysm of the left circumflex coronary artery presenting with accelerated angina pectoris: response to medical management--a case report

Coronary artery aneurysm is defined as coronary dilatation with a diameter of more than 1.5 times the adjacent normal coronary artery. Most of the coronary aneurysms remain asymptomatic. More than 90% of coronary aneurysms are of atherosclerotic origin. Nonatherosclerotic coronary aneurysms are rare, and the majority of them are diffuse. Among the three major coronary arteries, the left circumflex artery is the least commonly involved. The management strategies for nonatherosclerotic coronary aneurysms are not clear, and each case should be managed on an individual basis depending on the clinical context. Here described is a case of a discrete nonatherosclerotic aneurysm of the left circumflex coronary artery in a 46-year-old man who presented with accelerated angina pectoris and was treated medically. The patient was free of symptoms on 2-year follow-up. The clinical perspectives of the nonatherosclerotic coronary aneurysm are discussed.

Giant noninflammatory and nonatherosclerotic coronary arterial aneurysm in the left main trunk assessed by intravascular ultrasound imaging--a case report

A case of a giant noninflammatory and nonatherosclerotic coronary arterial aneurysm in the left main trunk of a 69-year-old female is reported. Preoperative intravascular ultrasound (IVUS) images were helpful for visualizing the morphologic and histologic features of the coronary aneurysm. They were also useful for determining the etiologic background and surgical procedure.

Saphenous vein graft ectasia: an unusual late complication of coronary artery bypass surgery. A case report

Aneurysms and ectasias of saphenous vein grafts are infrequent complications of coronary artery bypass surgery. They usually present as an expanding asymptomatic mediastinal mass on chest x-ray film or computed tomography scan. Though rare, they must be excluded from the differential diagnosis of mediastinal masses to avoid potentially dangerous needle biopsy. The authors describe ectasia of a saphenous vein graft in a 62-year-old man 14 years after coronary artery bypass surgery. The relevant literature is also discussed.