Coronary ectasia complicated in - situ thrombosis

ABSTRACT

Coronary Ectasia [CE] is the abnormal enlargement or irregular dilatation of coronary arteries. We present a case of a 39-year-old male patient who presented with central chest pain of one-hour duration. His admission ECG showed 2 mm ST depression in I, aVL, V5, V6. Serial cardiac enzymes were normal. He was treated as a case of unstable angina with intravenous heparin. Nitrates, aspirin, and atenolol. His INR on admission was 1.3 [i.e.; subtherapeutic] Coronary angiography showed moderate ectasia in the proximal segments of left anterior descending and circumflex vessels. There was severe [almost aneurismal] ectasia of the proximal and mid segments of the right coronary artery [RCA] with a large intra-luminal filling defect suggestive of thrombus and slow- TIMI 1 grade-flow. The patient was managed with systemic intravenous thrombolysis by streptokinase [100,000 unit/ hour for 24 hours] and was continued on heparin and restarted on warfarin to keep INR between 2-3. His subsequent hospital course was uneventful. A brief discussion of ectasia and its significance and treatment is provided