Medical Student Midwestern University/AZCOM Glendale, Arizona, United States
Clinical Scenario or Case: 65-year-old man with hypertension, hyperlipidemia, prediabetes, and a history of smoking was referred for preoperative evaluation. He has mild chest pain. EKG and Echocardiogram are unremarkable. Nuclear stress testing revealed a small area of reversible ischemia. Coronary angiography demonstrated diffuse coronary artery aneurysmal dilation without significant stenosis. Treated with anticoagulation and follow up 4 years later.
Evidence/Literature Review: Coronary artery aneurysm (CAA) is a very rare condition affecting coronary arteries. Atherosclerosis and vasculitis (such as Kawasaki disease) usually involve more than one artery, while congenital and iatrogenic CAA typically affect only one vessel. We present the case of patient with diffuse coronary artery aneurysmal dilation and treated with anticoagulation, follow up for 4 years, with reduction of chest pain
Unique Aspects of Case: The treatment with anticoagulation for dilated CAA is still unclear, regardless of whether the cause is atherosclerosis or Kawasaki disease. According to current guidelines, anticoagulation is only recommended for Kawasaki disease if there is a large or giant aneurysm. However, this is a class IIA recommendation, meaning it should be considered based on the clinical situation. In our case, the angiogram showed slow flow in the LAD with a low TIMI score. Therefore, we decided to start the patient on anticoagulant therapy with Apixaban 5 mg twice a day. The patient is required to follow up annually, and after four years, he reports no symptoms except occasional chest pressure while hiking. This case suggests that anticoagulation can be beneficial for patients with diffuse dilated CAA.
Recommendations/Conclusions: This case shows that Kawasaki disease can occur in adults and lead to diffuse coronary artery aneurysms (CAA). The best way to diagnose this condition is through coronary angiography. Anticoagulant treatment may be beneficial for these patients. Long-term follow-up is important to monitor the patient's symptoms.
