Coronary artery aneurysm: A review

Abstract

Summary: Coronary artery ectasia (CAE) is found in 0.3-5% of patients undergoing coronary angiography. Atherosclerosis is the main cause, followed by Kawasaki disease and infectious emboli. The exact pathogenesis has not been diagnosed as yet, but an inflammatory process is underlying. Symptoms, if present, are usually related to myocardial ischemia. Angiography is the mainstay for diagnosis. The prognosis is generally favorable. Thromboembolic complications are rare with antiplatelet therapy, and spontaneous rupture generally is rare but occurs more commonly in Kawasaki disease. Management varies from antithrombotic therapy to surgical ligation. Controlling coronary heart disease risk factors sharply affects the prognosis in patients with CAE.

Kawasaki Disease: The Coronary Affection Perspective

“…The appearance of aneurysms more than 6 weeks after the onset of illness is uncommon. Factors associated withan increased risk of developing coronary arterial aneurysms include male gender; age less than 1 year; other signs or symptoms of pericardial, myocardial, or endocardial involvement, including arrhythmias; prolonged period of inflammation, including fever for more than 10 days; and the recurrence of fever after an afebrile period of at least 48 hours [49].…”

“…Chest pain has been described by children who can communicate the symptom. The majority of documented cases of infarction occur during sleep or while at rest [48,49].…”

“…Later, therapy is directed toward preventing coronary thrombosis by inhibiting platelet aggregation [49]. Specific therapy awaits discovery of the etiologic agent.…”

“…By the seventh week after enrollment, the difference between the two groups was not significant. Children treated with the single-infusion regimen also had more rapid defervescence and return of acute phase reactants to normal [49]. Intravenous gamma globulin has been reported to reduce the [plus] Aspirin 80-100 mg/kg per day orally in four equally divided doses until patient is afebrile*, Then3-5 mg/kg orally once daily for up to 6-8 weeks** Newer studies have shown that high single doses are more effective.…”

“…**Discontinue aspirin 6-8 weeks after onset of illness if no coronary arterial abnormalities are observed on echocardiogram. Continue indifinetly if there are coronary arterial abnormalities [49].…”