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Diffuse aneurysmal disease

A 72-year-old woman admitted for non-ST-elevation myocardial infarction (MI) had medical history notable for coronary artery disease with two episodes of MI that were diagnosed at an outlying hospital and treated medically. She was also noted to have an infrarenal abdominal aneurysm for the preceding 5 years, measured most recently at 4.8 cm and also managed medically. Other past medical history included hypertension, chronic obstructive pulmonary disease, hyperlipidemia, and peripheral vascular disease with left femoropopliteal bypass surgery. On admission, the patient’s vital signs were stable, but her cardiac markers were elevated with peak troponin-I at 37 ng/ml. Her electrocardiogram showed ST depression in the inferior leads. She was treated with unfractionated heparin and eptifibatide. Coronary angiography revealed triple-vessel coronary artery disease with multiple coronary artery aneurysms in the right coronary artery (RCA) and left anterior descending artery. The largest aneurysm in the proximal RCA measured 2.7 3.1 cm. The patient underwent triple-vessel coronary artery bypass surgery with no complications. Giant coronary artery aneurysm is a rare entity that has been previously reported.1 Association with other aneurysmal diseases such as abdominal aneurysm has also been reported, but remains a very rare phenomenon.2, 3 Underlying causes associated with dilatations of blood vessels systemically include degenerative processes (atherosclerosis being a major cause), infections (such as syphilis), inflammation (such as Kawasaki Disease and Behcet’s syndrome2), and congenital anomalies.