Abstract 14630: Young Female Presenting With Chest Pain Due to Left Main Aneurysm

Abstract

Background: Incidence of ACS is increasing in young patients. While atherosclerosis needs to be ruled out, there should be high suspicion for alternate causes. Case: A 36-year-old African American woman with obesity, prediabetes and tobacco use, presented to the ED with chest pain. Initial cardiac investigations unremarkable. CTA chest ruled out pulmonary embolism and aortic dissection. Her pain had resolved and she was discharged home. Within hours, the pain recurred and became progressively worse. She returned to the ED and was found to have an anterior STEMI with a troponin I 0.72 ng/ml. Cardiology was consulted, left heart cath revealed a large left main aneurysm (LMA) with large thrombus burden, with mildly aneurysmal LAD, RCA and LCx, moderate decrease in systolic function and no significant arch or main vessel aneurysms. Case was discussed with cardiothoracic surgery, who recommended medical management. Her symptoms resolved while on anticoagulation. Discussion: Coronary artery aneurysms (CAA) are a rare cause of ACS. The reported incidence of CAA ranges from 0.3% to 5%, most often affecting men. The RCA is the most commonly affected artery followed by the LAD, with the LM being the least common. Risk factors include hypertension, dyslipidemia, smoking, diabetes, and a family history of coronary artery disease. Known etiologies include atherosclerosis, Kawasaki disease, inflammatory, congenital, and degenerative conditions. Transient myocardial ischemia may result from aneurysm-related blood stasis that may predispose to thromboembolic events, coronary spasm, and microvascular dysfunction. Conclusion: Although considered extremely rare, the number of LMA reported has increased in the last decades and may continue to grow with the widespread use of invasive and noninvasive coronary imaging. Considering the rarity of CAA and absence of dedicated studies, both the interventional and the pharmacological management of patients with LMA are challenging.