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The pain had no radiation and started while he was watching TV. He denied associated nausea, vomiting, palpitations or shortness of breath. He has history of hypertension controlled with irbesartan. He never smoked or drank alcohol. Exam showed normal vital signs; cardiovascular examination showed regular rate and rhythm, no gallops, murmurs or pericardial rub, had symmetric and bounding distal pulses.
Electrocardiogram showed normal sinus rhythm with no ST or T wave changes, and with normal intervals. Chest X-ray was normal. Laboratory studies showed elevated cardiac enzymes: Surprisingly, he had diffuse triple coronary artery ectasia with no evidence of focal stenosis or thrombosis Figure 1.
No intervention was done since there was no coronary stenosis. The patient was started on aspirin, clopidogrel and enoxaparin with bridging to coumadin on discharge. Right coronary angiogram recorded in the right anterior oblique cranial view showing severe diffuse coronary artery ectasia of the posterior descending and right coronary artery arrow.
Coronary artery ectasia is defined as an arterial segment dilatation at least 1. In this case, the presence of triple coronary artery ectasia with absence of significant cardiac risk factors prompted the diagnosis of adult Kawasaki disease. The aim of management of coronary artery ectasia is preventing formation of thrombus within these vessels. A paucity of evidence evaluating treatment of coronary artery ectasia is available; however, recommendations are to start patients on an anti-platelet agent such as aspirin and long-term anticoagulation with warfarin to prevent thrombus formation.
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