Giant Coronary Artery Aneurysm Rupture After a Heart Attack: A Rare and Fatal Case

Coronary artery aneurysm (CAA) is a rare but serious condition that can lead to complications such as thrombosis, embolization, myocardial infarction, and rupture. A recent case study published in the Journal of Cardiology and Cardiovascular Medicine describes a 42-year-old patient who suffered a ruptured coronary artery aneurysm following a heart attack, ultimately leading to cardiac arrest.

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Case Summary

A 42-year-old man arrived at the emergency department with chest pain lasting two hours. Medical evaluations showed:

• ST-segment elevation myocardial infarction (STEMI) in leads V1-V4
• Elevated Troponin I (39.6 ng/ml) and CK-MB (24.5 ng/ml)
• A giant coronary artery aneurysm (20×40 mm) in the left anterior descending (LAD) artery

The aneurysm contained a large thrombus blocking blood flow, prompting emergency thrombolytic therapy. However, before surgery could be performed, the patient experienced massive pericardial effusion and cardiac tamponade, leading to a fatal coronary rupture.

A detailed analysis can be found in the main journal article.

Understanding Coronary Artery Aneurysms

CAA is defined as a localized dilation of a coronary artery exceeding 50% of the normal vessel diameter. It can be fusiform (involving the full circumference) or saccular (affecting only a portion of the vessel).

Common causes include:

• Atherosclerosis (50% of cases)
• Kawasaki disease
• Polyarteritis nodosa
• Infections, trauma, or congenital malformations

The abnormal blood flow within an aneurysm can lead to thrombus formation, ischemia, and infarction, increasing the risk of rupture.

The American Heart Association (AHA) highlights the importance of early detection and intervention for high-risk cardiac conditions like aneurysms to improve survival outcomes.

Treatment and Management

Management of coronary artery aneurysms depends on factors such as size, location, and associated risks. Common approaches include:

• Thrombus aspiration or percutaneous coronary intervention (PCI)
• Thrombolysis for high thrombus burden
• Surgical intervention (CABG or aneurysm repair) for high-risk cases

In this case, thrombolysis was chosen as the primary treatment, but urgent surgery was planned. Unfortunately, the patient’s condition deteriorated before the procedure could be performed.

Real-World Implications

This case highlights the need for early diagnosis and prompt intervention in patients with coronary aneurysms. Key takeaways include:

✔ Screening high-risk patients, especially those with atherosclerosis or previous MI
✔ Immediate surgical evaluation for large aneurysms with high thrombus burden
✔ Multidisciplinary decision-making to optimize treatment strategies

Conclusion

Giant coronary artery aneurysms are rare but can cause severe complications, including rupture and sudden death. Early detection, timely intervention, and personalized treatment plans are crucial in improving patient outcomes.

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Disclaimer

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