Giant Coronary Artery Ectasia Presenting with ST Elevation Myocardial Infarction

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Background: During routine coronary angiography we often come across coronary artery ectasia (CAE). Patients with coronary ectasia can present with acute coronary syndrome due to a large thrombus burden requiring emergency intervention or anticoagulation.

Case: 56-year-old diabetic, a nonsmoker, presented with chest pain lasting for more than twelve hours. On examination, he was hemodynamically stable, and cardiac auscultation was unremarkable.ECG sinus rhythm and suggestive of anteroseptal myocardial infarction, repeat ECG after loading with DAPT and heparin revealed ST-segment resolution. An echocardiogram showed hypokinesia of the anteroseptal and apical anterior wall, an LV ejection fraction of 56%. Coronary angiogram revealed Non-obstructive giant ectatic coronaries with slow contrast clearance, patient had an episode of ventricular tachycardia during a coronary angiogram, DC cardioverted. The patient was initially on parenteral LMWH and DAPT. He was discharged with antiplatelet (Aspirin 75 mg once a day) and anticoagulants (Rivaroxaban 2.5 mg 12th hourly), beta-blocker. Cardiac CT revealed Mild coronary artery disease with a calcium score – 30, and no significant coronary artery stenosis. Diffusely ectatic coronary arteries.

Conclusion: We highlight this case due to a lack of consensus approach in the management of CAE and long-term follow-up due to the inadequacy of prospective studies.