DISCUSSION
This patient had a right CAA and CAE of LAD and LCX. He experienced sudden onset retrosternal chest pain at rest without any exacerbating activity with no prior episode. Initially, he was suspected to be a case of myocardial infarction, but on complete workup, an aneurysm of the right coronary artery was the main culprit causing the symptoms.
With a frequency of 1.2–4.9% and affecting the RCA in 50%, coronary artery aneurysms are usually asymptomatic and discovered by chance during angiography3. CAA can be characterised based on morphology or coronary artery distribution, with atherosclerosis accounting for 50% of CAA4. Kawasaki illness is responsible for 17% of instances that usually affects infants and children but may emerge in adulthood5. Mycotic and infectious septic emboli from illnesses like syphilis and borreliosis are rarer causes, accounting for 11% of CAA. Even more unusual causes of CAA include Marfan’s syndrome, arteritides such as polyarteritis nodosa, Takayasu’s disease, systemic lupus erythematosus, neurofibromatosis, primary cardiac lymphoma, and congenital conditions5. Iatrogenic CAA has also been linked to drug-eluting stents and balloon angioplasty6. Angina pectoris, myocardial infarction, sudden death, fistula development, rupture with hemopericardium or tamponade, compression of adjacent tissues, or congestive heart failure can be the presenting condition of a patient with CAA6. Furthermore, though extremely rare, CAA can be misleading as para cardiac or intracardiac masses7. For the differential diagnosis of an aneurysm, echocardiography, coronary CTA, and magnetic resonance imaging (MRI) are essential. Because of its superior soft-tissue contrast and various manipulable characteristics, MRI is the most sensitive tool for assessing tissue in the case of a tumour. Furthermore, coronary angiography helps confirm the diagnosis of coronary artery aneurysm and myocardial infarction, which aids the surgical approach8.
CAA has a mixed prognosis, with a 5-year survival rate of approximately 71 percent6. The management of coronary artery aneurysms includes medical intervention, stent insertion and surgical resection8. For small asymptomatic coronary aneurysms, conservative or medical therapy is preferable. To reduce the risk of thromboembolic consequences, these patients are treated aggressively with changes in cardiovascular risk factors, antiplatelet medication, and anticoagulation, with 3-monthly monitoring recommended9. Surgical intervention is required when CAA and GCAA are causing symptoms. CABG, resection with end-to-end anastomoses, or interposition vein graft are among the surgical options available through a median sternotomy10. In individuals with a high surgical risk, coil embolization and percutaneous therapy with covered stent implantation have also been employed as non-surgical options5.