Coronary artery aneurysm

Coronary arteries
Causes| atherosclerosis, Kawasaki disease, coronary catheterization.
Diagnostic method| coronary angiography
Treatment| medical management, surgical excision, coronary bypass grafting (CABG), and percutaneous coronary interventions[1]

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.[2]

## Contents

* 1 Signs and symptoms
* 2 Causes
* 3 Diagnosis
* 4 Treatment
* 5 Prognosis
* 6 See also
* 7 References
* 8 External links

## 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.[3]

## Causes

Acquired causes include atherosclerosis in adults,[4] Kawasaki disease in children[5] 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.[2]

It can also be congenital.[6][7] The following risk factors are thought to be associated with coronary artery aneurysms:

1. Individual's genetic make-up, especially in patients with congenital coronary artery aneurysms
2. Coronary artery disease (atherosclerosis)
3. Vasculitic and connective tissue diseases (Kawasaki and Marfan)
4. Intracoronary manipulation leading to local wall stress (stent placement, angioplasty, brachytherapy)
5. Post-infectious as a consequence of direct wall infiltration or immune complex deposition[8]

## Diagnosis

It is often found coincidentally on coronary angiography.[3] 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.[2]

## 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.[2]

In patients with Kawasaki disease prompt administration of intravenous immunoglobulin (IVIG) therapy should be given to prevent complication of coronary artery aneurysm.[9]

## Prognosis

Generally, it has a good prognosis.[3] In Kawasaki's disease, untreated, there is a 1–2% death rate, from cardiac causes.[citation needed]

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.[2]

## See also

* Aneurysm
* Coronary artery ectasia

## References

1. ↑ 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.
2. ↑ 2.0 2.1 2.2 2.3 2.4 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. PMID 31620255.
3. ↑ 3.0 3.1 3.2 "Coronary artery aneurysm: a review". Clin Cardiol 29 (10): 439–43. October 2006. doi:10.1002/clc.4960291005. PMID 17063947.
4. ↑ "Coronary artery aneurysm: a review and hypothesis regarding etiology". Arch. Pathol. Lab. Med. 132 (5): 823–8. May 2008. doi:10.5858/2008-132-823-CAAARA. PMID 18466032. https://www.archivesofpathology.org/doi/full/10.1043/1543-2165(2008)132[823:CAAARA]2.0.CO;2.
5. ↑ "Coronary artery aneurysm induced by Kawasaki disease in children show features typical senescence". Circ. J. 71 (5): 709–15. May 2007. doi:10.1253/circj.71.709. PMID 17456996.
6. ↑ "Congenital coronary artery aneurysms". Br Heart J 36 (4): 329–35. April 1974. doi:10.1136/hrt.36.4.329. PMID 4842623.
7. ↑ "MRI of congenital coronary artery aneurysm". Br J Radiol 73 (867): 322–4. March 2000. doi:10.1259/bjr.73.867.10817051. PMID 10817051.
8. ↑ 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.
9. ↑ 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. PMID 28529940.

## External links

Classification|

* ICD-11: BA81
* ICD-10: I25.4
* ICD-10-CM: I25.41
* ICD-9-CM: 414.11
* MeSH: D003323
* SNOMED CT: 50570003

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External resources|

* Medicine:GARD: artery aneurysm Coronary artery aneurysm
* Radiopedia: 37916

* v
* t
* e

Cardiovascular disease (heart) (I00–I52, 390–429)

Ischaemic|

| 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
* Aneurysm of heart / Ventricular aneurysm
* Dressler syndrome

Layers|

| Pericardium|

* Pericarditis
* Acute
* Chronic / Constrictive
* Pericardial effusion
* Cardiac tamponade
* Hemopericardium

|

Myocardium|

* Myocarditis
* Chagas disease
* Cardiomyopathy
* Dilated
* Alcoholic
* Hypertrophic
* Tachycardia-induced
* Restrictive
* Loeffler endocarditis
* Cardiac amyloidosis
* Endocardial fibroelastosis
* Arrhythmogenic right ventricular dysplasia

Endocardium /
valves|

| Endocarditis|

* infective endocarditis
* Subacute bacterial endocarditis
* non-infective endocarditis
* Libman–Sacks endocarditis
* Nonbacterial thrombotic endocarditis

|

Valves|

* mitral
* regurgitation
* prolapse
* stenosis
* aortic
* stenosis
* insufficiency
* tricuspid
* stenosis
* insufficiency
* pulmonary
* stenosis
* insufficiency

Conduction /
arrhythmia|

| Bradycardia|

* Sinus bradycardia
* Sick sinus syndrome
* Heart block: Sinoatrial
* AV
* 1°
* 2°
* 3°
* Intraventricular
* Bundle branch block
* Right
* Left
* Left anterior fascicle
* Left posterior fascicle
* Bifascicular
* Trifascicular
* Adams–Stokes syndrome

|

Tachycardia
(paroxysmal and sinus)|

| Supraventricular|

* Atrial
* Multifocal
* Junctional
* AV nodal reentrant
* Junctional ectopic

|

Ventricular|

* Accelerated idioventricular rhythm
* Catecholaminergic polymorphic
* Torsades de pointes

Premature contraction|

* Atrial
* Junctional
* Ventricular

Pre-excitation syndrome|

* Lown–Ganong–Levine
* Wolff–Parkinson–White

Flutter / fibrillation|

* Atrial flutter
* Ventricular flutter
* Atrial fibrillation
* Familial
* Ventricular fibrillation

Pacemaker|

* Ectopic pacemaker / Ectopic beat
* Multifocal atrial tachycardia
* Pacemaker syndrome
* Parasystole
* Wandering atrial pacemaker

Long QT syndrome|

* Andersen–Tawil
* Jervell and Lange-Nielsen
* Romano–Ward

Cardiac arrest|

* Sudden cardiac death
* Asystole
* Pulseless electrical activity
* Sinoatrial arrest

Other / ungrouped|

* hexaxial reference system
* Right axis deviation
* Left axis deviation
* QT
* Short QT syndrome
* T
* T wave alternans
* ST
* Osborn wave
* ST elevation
* ST depression
* Strain pattern

Cardiomegaly|

* Ventricular hypertrophy
* Left
* Right / Cor pulmonale
* Atrial enlargement
* Left
* Right
* Athletic heart syndrome

Other|

* Cardiac fibrosis
* Heart failure
* Diastolic heart failure
* Cardiac asthma
* Rheumatic fever

* v
* t
* e

Cardiovascular disease (vessels) (I70–I99, 440–456)

Arteries, arterioles
and capillaries|

| Inflammation|

* Arteritis
* Aortitis
* Buerger's disease

|

Peripheral artery disease|

| Arteriosclerosis|

* Atherosclerosis
* Foam cell
* Fatty streak
* Atheroma
* Intermittent claudication
* Critical limb ischemia

* Monckeberg's arteriosclerosis
* Arteriolosclerosis
* Hyaline
* Hyperplastic
* Cholesterol
* LDL
* Oxycholesterol
* Trans fat

|

Stenosis|

* Carotid artery stenosis
* Renal artery stenosis

Other|

* Aortoiliac occlusive disease
* Degos disease
* Erythromelalgia
* Fibromuscular dysplasia
* 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

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
* 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|

* Angiopathy
* Macroangiopathy
* Microangiopathy
* Embolism
* Pulmonary embolism
* Cholesterol embolism
* Paradoxical embolism
* Thrombosis
* Vasculitis

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

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