CAR-6. Coronary ectasia: a rare manifestation of atherosclerosis with unsolved questions.

Coronary artery ectasia (CAE) is defined as a luminal diameter of epicardial coronary artery>1.5 times that of a normal segment. Although the underlying mechanism is unclear, it is considered as an atypical form of vascular remodeling in response to atherosclerosis. It is estimated that atherosclerosis presents in 50% of the cases, it has also been associated with vasculitides, trauma, hyperlipidemia, Kawasaki disease and coronary fistula. We discuss a patient with diffuse coronary artery ectasia who was presented with recurrent exertional chest pain. Pathogenesis, current understanding of the disease, complication and significance of coronary ectasia is discussed. The patient is a 42-year-old male with multiple risk factors for coronary atherosclerosis was presented to the hospital with exertional chest pain on and off for 1 year. His chest pain was typically for angina. It was associated with diaphoresis, aggravated by exertion and relieved by rest. The only outpatient medication was aspirin 325 mg/day. Physical examination was unremarkable except for mild obesity and mildly elevated blood pressure. Electrocardiogram showed normal sinus rhythm with rate of 76 and no ST-T changes or q waves. He was admitted and ruled out for acute myocardial infarction. EKG remained unchanged but he continued to have chest pain. Considering a high pre-test probability for coronary artery disease, he was scheduled for cardiac catheterization, which showed diffuse ectasia of his left circumflex artery (10 mm in diameter) and left anterior descending artery (6 mm in diameter). His left circumflex artery showed intracoronary swirling effect of the contrast suggestive of sluggish flow. Patient continues to have chest pain with repeated Emergency room visits. Although rare, Coronary artery ectasia presents a diagnostic and therapeutic challenge. It also carries an increase risk of myocardial infarction, rupture and sudden death. Risk factor modification and possibly anticoagulation with coumadin could be beneficial but further investigation is warranted.

Vipul Brahmbhatt, Baha Shabaneh, MD, Steve Smith, MD, and Jack Whitaker, MD. East Tennessee State University, Johnson City, TN.