Coronary artery aneurysm - Misplaced Pages

Medical condition

Coronary artery aneurysm

Coronary arteries
Specialty	Cardiology
Causes	atherosclerosis, Kawasaki disease, coronary catheterization.
Diagnostic method	coronary angiography
Treatment	medical management, surgical excision, coronary bypass grafting (CABG), and percutaneous coronary interventions

Coronary artery aneurysm is an abnormal dilatation of part of the coronary artery. This rare disorder occurs in about 0.3–4.9% of patients who undergo coronary angiography.

Signs and symptoms

The majority of individuals suffering from coronary artery aneurysms do not exhibit any symptoms; the development of complications or concurrent atherosclerotic coronary artery disease is what causes clinical manifestations to occur. The most common complications include coronary spasm, distal embolization, aneurysm rupture, local thrombosis, and compression of surrounding structures due to massive enlargement of coronary artery aneurysm.

Causes

Acquired causes include atherosclerosis in adults, Kawasaki disease in children and coronary catheterization. With the invention of drug eluting stents, there has been more cases implying stents lead to coronary aneurysms. The pathophysiology, although not completely understood, might be comparable to that of aneurysms of larger vessels. This includes disruption of the arterial media, weakening of the arterial wall, increased wall strain and slow dilatation of the coronary artery portion.

It can also be congenital. The following risk factors are thought to be associated with coronary artery aneurysms:

Individual's genetic make-up, especially in patients with congenital coronary artery aneurysms
Coronary artery disease (atherosclerosis)
Vasculitic and connective tissue diseases (Kawasaki and Marfan)
Intracoronary manipulation leading to local wall stress (stent placement, angioplasty, brachytherapy)
Post-infectious as a consequence of direct wall infiltration or immune complex deposition

Diagnosis

It is often found coincidentally on coronary angiography. Other modalities that can be used to diagnose a coronary artery aneurysm include echocardiography, magnetic resonance imaging and computerized tomography. Although coronary angiography remains to be the gold standard, the invasive procedure comes with its associated risks, is more expensive than other modalities and the size of the aneurysm might be miscalculated if there is a thrombus in place.

Treatment

Treatment for coronary artery aneurysm include medical management, surgery and percutaneous intervention. Underlying coronary artery risk factors should be addressed in patients with atherosclerosis and proper guideline-mediated medications should be started. In those with risk for embolism or thrombosis, anti-platelet or anticoagulation therapy should be contemplated.

In patients with Kawasaki disease prompt administration of intravenous immunoglobulin (IVIG) therapy should be given to prevent complication of coronary artery aneurysm.

Prognosis

Generally, it has a good prognosis. The prognosis of coronary artery aneurysm is dependent on its diameter. The smaller the aneurysm the better the prognosis. There is less risk for ischemic myocardial damage and mortality with smaller aneurysms. Aneurysms with an internal diameter > 8 mm have poorer outcomes, since these aneurysms can be occluded and be associated with complications such as arrhythmias, myocardial infarction, or sudden death.

References

Kawsara, Akram; Núñez Gil, Iván J.; Alqahtani, Fahad; Moreland, Jason; Rihal, Charanjit S.; Alkhouli, Mohamad (2018-07-09). "Management of Coronary Artery Aneurysms". JACC: Cardiovascular Interventions. 11 (13): 1211–1223. doi:10.1016/j.jcin.2018.02.041. ISSN 1936-8798. PMID 29976357.
^ Sheikh, Azeem S.; Hailan, Ahmed; Kinnaird, Tim; Choudhury, Anirban; Smith, David (2019). "Coronary Artery Aneurysm: Evaluation, Prognosis, and Proposed Treatment Strategies". Heart Views. 20 (3): 101–108. doi:10.4103/HEARTVIEWS.HEARTVIEWS_1_19. ISSN 1995-705X. PMC 6791093. PMID 31620255.
^ Pahlavan PS, Niroomand F (October 2006). "Coronary artery aneurysm: a review". Clin Cardiol. 29 (10): 439–43. doi:10.1002/clc.4960291005. PMC 6654377. PMID 17063947.
Nichols L, Lagana S, Parwani A (May 2008). "Coronary artery aneurysm: a review and hypothesis regarding etiology". Arch. Pathol. Lab. Med. 132 (5): 823–8. doi:10.5858/2008-132-823-CAAARA. PMID 18466032.
Fukazawa R, Ikegam E, Watanabe M, et al. (May 2007). "Coronary artery aneurysm induced by Kawasaki disease in children show features typical senescence". Circ. J. 71 (5): 709–15. doi:10.1253/circj.71.709. PMID 17456996.
Seabra-Gomes R, Somerville J, Ross DN, Emanuel R, Parker DJ, Wong M (April 1974). "Congenital coronary artery aneurysms". Br Heart J. 36 (4): 329–35. doi:10.1136/hrt.36.4.329. PMC 1020027. PMID 4842623.
Meinert D, Mohammed Z (March 2000). "MRI of congenital coronary artery aneurysm". Br J Radiol. 73 (867): 322–4. doi:10.1259/bjr.73.867.10817051. PMID 10817051.
Kawsara, Akram; Núñez Gil, Iván J.; Alqahtani, Fahad; Moreland, Jason; Rihal, Charanjit S.; Alkhouli, Mohamad (2018-07-09). "Management of Coronary Artery Aneurysms". JACC: Cardiovascular Interventions. 11 (13): 1211–1223. doi:10.1016/j.jcin.2018.02.041. ISSN 1876-7605. PMID 29976357.
Abou Sherif, Sara; Ozden Tok, Ozge; Taşköylü, Özgür; Goktekin, Omer; Kilic, Ismail Dogu (2017-05-05). "Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment". Frontiers in Cardiovascular Medicine. 4: 24. doi:10.3389/fcvm.2017.00024. ISSN 2297-055X. PMC 5418231. PMID 28529940.

External links

Classification	D ICD-11: BA81 ICD-10: I25.4 ICD-10-CM: I25.41 ICD-9-CM: 414.11 MeSH: D003323 SNOMED CT: 50570003
External resources	GARD: Coronary artery aneurysm Radiopaedia: 37916

Cardiovascular disease (heart)

Ischemia

Coronary disease	Coronary artery disease (CAD) Coronary artery aneurysm Spontaneous coronary artery dissection (SCAD) Coronary thrombosis Coronary vasospasm Myocardial bridge
Active ischemia	Angina pectoris Prinzmetal's angina Stable angina Acute coronary syndrome Myocardial infarction Unstable angina
Sequelae	hours Hibernating myocardium Myocardial stunning days Myocardial rupture weeks Ventricular aneurysm Dressler syndrome

Layers

Pericardium

Myocardium

Endocardium /
valves

Endocarditis	infective endocarditis Subacute bacterial endocarditis non-infective endocarditis Libman–Sacks endocarditis Nonbacterial thrombotic endocarditis
Valves	mitral prolapse stenosis regurgitation aortic stenosis regurgitation tricuspid stenosis regurgitation pulmonary stenosis regurgitation

Conduction /
arrhythmia

Bradycardia

Tachycardia
(paroxysmal and sinus)

Supraventricular	Atrial Multifocal Junctional AV nodal reentrant Junctional ectopic
Ventricular	Accelerated idioventricular rhythm Catecholaminergic polymorphic Torsades de pointes

Premature contraction

Pre-excitation syndrome

Flutter / fibrillation

Other / ungrouped

Other

Cardiovascular disease (vessels)

Arteries, arterioles
and capillaries

Inflammation	Arteritis Aortitis Buerger's disease
Arteriosclerosis	Atherosclerosis Foam cell Fatty streak Atheroma Cholesterol LDL Oxycholesterol Trans fat Monckeberg's arteriosclerosis Hyaline arteriolosclerosis Hyperplastic arteriolosclerosis
Peripheral artery disease	Stenosis Carotid artery stenosis Renal artery stenosis Aortoiliac occlusive disease Critical limb ischemia Degos disease Erythromelalgia Fibromuscular dysplasia Hepatic artery thrombosis Intermittent claudication Raynaud's phenomenon
Aneurysm / dissection / pseudoaneurysm	torso: Aortic aneurysm Abdominal aortic aneurysm Thoracic aortic aneurysm Aneurysm of sinus of Valsalva Aortic dissection Aortic rupture Coronary artery aneurysm head / neck Intracranial aneurysm Intracranial berry aneurysm Carotid artery dissection Vertebral artery dissection Familial aortic dissection
Vascular malformation	Arteriovenous fistula Arteriovenous malformation Telangiectasia Hereditary hemorrhagic telangiectasia Generalized essential telangiectasia
Vascular nevus	Cherry hemangioma Halo nevus Spider angioma

Veins

Inflammation	Phlebitis
Venous thrombosis / Thrombophlebitis	primarily lower limb Deep vein thrombosis abdomen Hepatic veno-occlusive disease Budd–Chiari syndrome May–Thurner syndrome Portal vein thrombosis Renal vein thrombosis upper limb / torso Mondor's disease Paget–Schroetter disease Pulmonary embolism head Cerebral venous sinus thrombosis Post-thrombotic syndrome
Varicose veins	Gastric varices Portacaval anastomosis Caput medusae Esophageal varices Hemorrhoid Varicocele
Other	Chronic venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer

Arteries or veins

Blood pressure

Hypertension	Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension
Hypotension	Orthostatic hypotension Shock (circulatory)

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