Spontaneous Rupture of a Giant Coronary Artery Aneurysm After Acute Myocardial Infarction

Introduction

Coronary artery aneurysms (CAA) are rare yet life-threatening conditions characterized by abnormal dilatation of the coronary artery. These aneurysms, when left untreated, pose a high risk of thrombus formation, embolization, and even rupture. A recent case highlights the devastating effects of a giant coronary artery aneurysm leading to fatal complications post-myocardial infarction.

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Case Summary

A 42-year-old male with no history of diabetes or hypertension presented with chest pain lasting two hours. Initial diagnostic tests revealed:

• Electrocardiography (ECG): ST-segment elevation in leads V1 to V4, indicative of an anteroseptal myocardial infarction.
• Echocardiography: Segmental wall motion abnormalities without pericardial effusion.
• Laboratory Findings: Elevated Troponin I (39.6 ng/ml) and creatine kinase-myocardial band (24.5 ng/ml).
• Coronary Angiography: A giant 20×40 mm aneurysm in the left anterior descending (LAD) artery with a massive thrombus obstructing blood flow.

Despite thrombolytic therapy with tissue plasminogen activator (tPA), TIMI III flow was only restored to the first diagonal artery, while the distal LAD remained occluded. Emergency surgical intervention was planned but, tragically, the patient’s condition deteriorated, leading to cardiac tamponade and fatal coronary rupture.

Clinical Significance and Implications

Coronary artery aneurysms can develop due to atherosclerosis, Kawasaki disease, polyarteritis nodosa, infection, trauma, or congenital malformations. The abnormal blood flow within an aneurysm increases the likelihood of thrombus formation, myocardial infarction, and rupture.

The American Heart Association (AHA) emphasizes the importance of early diagnosis and intervention in managing coronary artery anomalies. Current treatment options include:

• Thrombus aspiration to remove obstructive clots
• Percutaneous coronary intervention (PCI) with or without stenting
• Thrombolytic therapy to dissolve thrombi
• Surgical repair for large or high-risk aneurysms

Timely intervention is critical, as demonstrated by this case where surgical delays proved fatal.

Full Study Access and Further Research

For a detailed analysis of this case, read the full study at https://doi.org/10.29328/journal.jccm.1001009.

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