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The disease is commonly asymptomatic and is normally discovered when performing tests for other conditions such as coronary artery disease, stable angina and other acute coronary syndromes. [2] [3] Coronary artery ectasia occurs 4 times more frequently in males than in females and in people who have risk factors for heart disease such as smokers.
The smaller the aneurysm the better the prognosis. There is less risk for ischemic myocardial damage and mortality with smaller aneurysms. Aneurysms with an internal diameter > 8 mm have poorer outcomes, since these aneurysms can be occluded and be associated with complications such as arrhythmias, myocardial infarction, or sudden death. [2]
Aneurysms may affect the right (65–85%), non-coronary (10–30%), or rarely the left (< 5%) coronary sinus. [1] These aneurysms may not cause any symptoms but if large can cause shortness of breath, palpitations or blackouts. Aortic sinus aneurysms can burst or rupture into adjacent cardiac chambers, which can lead to heart failure if untreated.
The coronary arteries can constrict as a response to various stimuli, mostly chemical. This is known as a coronary reflex. There is also a rare condition known as spontaneous coronary artery dissection, in which the wall of one of the coronary arteries tears, causing severe pain. [10]
A true aneurysm is one that involves all three layers of the wall of an artery (intima, media and adventitia).True aneurysms include atherosclerotic, syphilitic, and congenital aneurysms, as well as ventricular aneurysms that follow transmural myocardial infarctions (aneurysms that involve all layers of the attenuated wall of the heart are also considered true aneurysms).
Coronary angiography should only be performed if a patient is a willing to undergo a coronary revascularization procedure. [37] During this test the doctor makes a small incision in the patient's groin or arm and inserts a catheter. [35] The catheter has a very small video camera on the end of it so that the doctor can find the arteries. [29]
Tests to help find out the location, size, and rate of growth of an aneurysm include: [citation needed] Abdominal ultrasound - This imaging allows the doctor to observe growth of the aneurysm. If the aneurysm is large, a monitoring ultrasound may need to occur every 6 to 12 months. If the aneurysm is small, monitoring may occur every 2 to 3 years.
Thoracic aneurysms are less common than an abdominal aortic aneurysm. [2] However, a syphilitic aneurysm is more likely to be a thoracic aortic aneurysm than an abdominal aortic aneurysm. This condition is commonly treated via a specialized multidisciplinary approach with both vascular surgeons and cardiac surgeons .