Severe Coronary Artery Ectasia in a 31-Year-Old Presenting With an Inferior ST-Elevation Myocardial Infarction: A Case Report

Coronary artery ectasia (CAE) is a rare dilation of the lumen in coronary arteries, either localized to one vessel or diffuse in multiple vessels. A 31-year-old white male with no significant past medical or cardiac history, presented with severe sudden onset chest pain, diaphoresis, shortness of breath, and nausea without vomiting. A 12 lead electrocardiogram (EKG) showed an ST elevation in the inferior leads with reciprocal changes, suggestive of myocardial infarction in the right coronary artery (RCA). He was taken directly to the catheterization laboratory for coronary angiography, which identified a mid-RCA thrombus with thrombolysis in myocardial infarction (TIMI)-1 flow, and distal to that in the right posterolateral branch was another thrombus with TIMI-0 flow. Additionally, he was found to have severely diffuse CAE in all of his coronary arteries. Angioplasty successfully restored TIMI-3 flow throughout the RCA. We present this case to discuss the prevention of complications from CAE. There are currently no recommendations on the use of antiplatelet or anticoagulation therapy in patients with CAE.