Abstract
Coronary artery ectasia (CAE) is a rare form of aneurysmal coronary heart disease. It is defined as a dilatation of the coronary artery by more than one-third of its length and with a diameter 1.5 times of a normal coronary artery adjacent to it. This condition increases the risk of angina pectoris and acute coronary syndrome. Hence, we discuss the pharmacologic options for primary and secondary prevention of CAE complications. Antiplatelets such as aspirin are considered the mainstay of treatment in patients with CAE. Anticoagulants such as warfarin are warranted on a case-by-case basis to prevent thrombus formation depending on the presence of concomitant obstructive coronary artery disease and the patient’s risk of bleeding. Since atherosclerosis is the most common cause of CAE, statins are indicated in all patients for primary prevention. Angiotensin-converting enzyme (ACE) inhibitors may be indicated, especially in hypertensive patients, due to their anti-inflammatory properties. Beta-blockers may be indicated due to their antihypertensive and anti-ischemic effects. Calcium (Ca) channel blockers may be needed to prevent coronary vasospasm. Nitrates are generally contraindicated as they may lead to worsening of symptoms. Other antianginal medications such as trimetazidine can improve exercise tolerance with no reported adverse events in these patients.
Highlights
BackgroundCoronary artery ectasia (CAE) is a rare abnormal aneurysmal dilatation of the coronary arteries
We focus on the pharmacologic therapy options for CAE, their role in management, and the relation of this role to the pathogenesis, the clinical picture, and complications
Yasar et al discovered that 32 patients with isolated CAE without associated coronary artery stenosis had significantly higher levels of P-selectin, betathromboglobulin, and platelet factor 4 (PF4) compared to a control group with normal coronary arteries (P
Summary
Coronary artery ectasia (CAE) is a rare abnormal aneurysmal dilatation of the coronary arteries. Sorrel et al were the first to propose Ca Channel blockers for the management of CAE along with aspirin and warfarin They based their recommendation on case reports and the high association between CAE and the incidence of clinical complications such as coronary thrombus formation and vasospasms. They attributed the use of Ca channel blockers to their anti-spasm effects [25]. A study by Beltrame et al demonstrated the effects of mibefradil, a T-type Ca channel blocker, in ameliorating the coronary slow flow phenomenon in 20 patients This medication significantly improved the TFC (P
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