Left main coronary artery aneurysm

Abstract

A 55-year-old woman presented with acute chest pain radiated to her jaw and left arm. She denied any history of dyspnea, orthopnea, dizziness or sweating. Her medical history was notable for hypertension, obstructive sleep apnea and obesity status after gastric bypass surgery 10 years ago. Medications included simvastatin, metoprolol, furosemide and folic acid. She drinks alcohol occasionally with no smoking or illicit drug abuse. On examination, her vitals were within normal limits. Her physical examination was unremarkable. Electrocardiogram showed T-wave inversion in lead II, without ST-segment changes. After the administration of sublingual nitroglycerin, her chest pain was substantially reduced, and she remained hemodynamically stable. Troponin T levels were positive at 0.106. The rest of her laboratory results were normal. On subsequent coronary angiography, the patient was noted to have a 1.8-cm saccular aneurysm that involved the distal portion of the left main (LM) coronary artery and extended into the origin of left anterior descending (LAD) and left circumflex (LCx) coronary arteries, with no significant coronary stenosis (Figure 1). Aspirin therapy was started. She was maintained on aspirin 81 mg daily without additional antiplatelet or anticoagulant therapy. She was discharged in stable condition with follow-up appointment in the cardiology clinic.