OVERVIEW

What is coronary artery ectasia?

The coronary arteries are blood vessels that supply nutrients to the heart.

Coronary artery ectasia refers to the dilation of the epicardial coronary arteries caused by various factors. The dilation can be localized or diffuse, with the diameter of the affected coronary artery exceeding 1.5 times that of the adjacent normal coronary artery. If the dilation exceeds twice the normal diameter, it is termed "coronary artery aneurysm" or "aneurysmal dilation."

Treatment for coronary artery ectasia includes medication, surgical intervention, and interventional therapy. Most patients can achieve effective symptom relief with active treatment.

What are the types of coronary artery ectasia?

The coronary arteries are divided into two main branches: the left and right coronary arteries. The left coronary artery further branches into the left anterior descending artery and the left circumflex artery, while the right coronary artery divides into the posterior descending artery and the posterolateral branch.

Based on the extent of coronary artery involvement, coronary artery ectasia can be classified into four types:

• Type I: Diffuse dilation in two or three coronary arteries;
• Type II: Diffuse dilation in one coronary artery and localized dilation in another;
• Type III: Diffuse dilation in only one coronary artery;
• Type IV: Localized dilation in only one coronary artery.

SYMPTOMS

What are the manifestations of coronary artery ectasia?

• The most common symptom of coronary artery ectasia is angina pectoris, typically presenting as sudden left chest pain with a pressing or squeezing sensation. The pain may radiate to the left arm, left neck, or left jaw.

• Coronary artery ectasia rarely progresses severely enough to cause myocardial infarction.

• When arterial dilation spontaneously leads to arterial dissection, malignant arrhythmias or sudden death may occur.

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What consequences can coronary artery ectasia cause?

• Rupture of a coronary artery aneurysm may lead to cardiac tamponade, acute heart failure, or shock.
• Spontaneous arterial dissection can result in malignant arrhythmias, leading to cardiac arrest.

The aforementioned adverse outcomes may be life-threatening.

CAUSES

What are the causes of coronary artery ectasia?

• Atherosclerosis: This cause accounts for about half of all cases of coronary artery ectasia. The blood vessel wall consists of three layers: intima, media, and adventitia. When atherosclerotic lesions affect the vascular media, the muscular elastic fibers are significantly damaged and reduced, causing the weakened vessel wall to bulge outward, leading to coronary artery ectasia.

• Kawasaki disease: This cause accounts for about one-fifth of all cases and is the most common cause of coronary artery ectasia in children. Kawasaki disease is an immune-mediated systemic vasculitis. Approximately 15%–25% of untreated children with Kawasaki disease develop coronary artery ectasia 3–6 months after the acute phase.

• Takayasu arteritis: This cause accounts for about one-tenth to one-fifth of all cases. Takayasu arteritis can occur in patients with systemic lupus erythematosus, scleroderma, Marfan syndrome, etc.

• Infectious diseases: This cause accounts for about one-tenth of all cases. Infectious diseases that can lead to coronary artery ectasia include syphilis and fungal infections.

• Others: For example, mechanical damage to the elastic fibers of the coronary artery media or hypersensitivity reactions to polymers.

Who is more likely to develop coronary artery ectasia?

• Men;

• Patients with hypertension or hyperlipidemia;

• Individuals with a long-term smoking history.

DIAGNOSIS

What tests are needed to diagnose coronary artery ectasia?

• Coronary angiography: This is the primary method for diagnosing coronary artery ectasia, helping doctors understand the shape of the aneurysm, abnormal blood flow, lesion location, and the number of affected vessels.

• Intravascular ultrasound (IVUS): Helps doctors differentiate between true and false aneurysms.

• Vascular ultrasound: This is particularly valuable for diagnosing coronary artery ectasia caused by Kawasaki disease in adolescents and can also assess aortic dilation and cardiac structure.

• Coronary CT and MRI: These imaging techniques provide a comprehensive evaluation of the coronary arteries, accurately depicting their origin, course, and lesions, while also showing blood flow and thrombus conditions.

What precautions should be taken for coronary angiography in coronary artery ectasia?

• Coronary angiography requires contrast injection, which may cause allergic reactions. Patients should inform their doctor of any allergies and sign a consent form before the procedure.

• Fasting for 4 hours is required before the examination.

• Diabetic patients taking metformin should adjust or discontinue the medication before and after the procedure based on kidney function test results. Drinking plenty of water and urinating after the examination helps prevent contrast-induced nephropathy.

Which diseases can coronary artery ectasia be easily confused with?

Coronary artery ectasia caused by Kawasaki disease should be differentiated from coronary artery fistula and anomalous origin of the left coronary artery from the pulmonary artery. Typically, Kawasaki disease diagnosis requires meeting at least 5 of the following 6 major symptoms:

• Fever lasting more than 5 days;
• Bilateral conjunctival congestion;
• Changes in lips and oral cavity (e.g., strawberry tongue);
• Polymorphous rash;
• Changes in extremities (e.g., hard edema in the acute phase);
• Acute non-suppurative cervical lymphadenopathy.

TREATMENT

Which department should I visit for coronary artery ectasia?

Cardiology.

How to provide first aid for angina caused by coronary artery ectasia?

If a patient with coronary artery ectasia experiences angina symptoms, call 120 immediately for medical assistance. Stay calm, sit or recline, and avoid unnecessary movement to prevent worsening cardiac ischemia.

How is coronary artery ectasia treated?

• Medication: Drugs cannot cure coronary artery ectasia but aim to prevent or reduce angina, myocardial infarction, and thrombotic events.

• Interventional therapy: PCI may be considered for coronary artery ectasia in infarction-related arteries. Polytetrafluoroethylene (PTFE) treatment can shrink or eliminate aneurysms with diameters of 5.8–10 mm.

• Surgical treatment: Surgery is the preferred option for left main artery aneurysms larger than 10 mm or 3–4 times the diameter of the originating vessel.

What types of medications are used for coronary artery ectasia?

• Anticoagulants: Warfarin;
• Antiplatelet drugs: Aspirin;
• Antispasmodics: Diltiazem;
• Anti-ischemic drugs: Beta-blockers, Trimetazidine;
• Anti-inflammatory drugs: Statins.

Medication should be chosen under a doctor's guidance. Self-medication or switching drugs is strongly discouraged.

Do coronary artery ectasia patients need to continue medication after improvement?

The need for continued medication depends on the patient's condition and follow-up results.

For example, coronary artery ectasia caused by Kawasaki disease in adolescents requires blood tests, ECG, and echocardiography after 3 months of medication to determine if discontinuation is possible.

Do coronary artery ectasia patients need follow-up after discharge?

Yes.

• Asymptomatic, untreated mild cases without discomfort should undergo ECG and echocardiography every 6–12 months.

• Treated patients are generally advised to follow up every 3 months.

Can coronary artery ectasia be completely cured?

With active treatment, symptoms can improve to varying degrees. Most cases caused by Kawasaki disease can be fully cured.

Surgery or interventional therapy provides relief, but complete recovery depends on the patient's overall health.

Can coronary artery ectasia recur?

The recurrence rate for isolated coronary artery ectasia is low (7.7%). However, patients with comorbid coronary heart disease have a significantly higher recurrence rate of 14%.

DIET & LIFESTYLE

What should patients with coronary artery ectasia pay attention to in their diet?

• Maintain a light diet, low in salt and fat;

• Eat less fatty meat, animal organs, fried foods, etc.;

• Eat more vegetables and a moderate amount of fruit;

• Avoid overeating and binge eating;

• Avoid strong tea, coffee, and alcohol.

What should patients with coronary artery ectasia pay attention to in daily life?

• Strictly follow the doctor's instructions, take medication on time and in the prescribed dosage, and do not stop medication without authorization;

• Have regular check-ups to monitor the condition and side effects of medications;

• Patients and their families should learn about coronary artery ectasia to recognize worsening symptoms promptly and seek immediate medical attention;

• Maintain regular bowel movements and avoid straining during defecation;

• Strictly quit smoking and alcohol.

Can patients with coronary artery ectasia exercise?

When the condition is stable or after active treatment, patients can engage in moderate aerobic exercise, such as walking, cycling, or Tai Chi, but should avoid strenuous exercise.

How should family members care for a patient with coronary artery ectasia?

Encourage the patient to take medication regularly and quit smoking and alcohol. If the patient experiences symptoms such as difficulty breathing, angina, or fainting, they should be sent to the hospital immediately for treatment.

PREVENTION

How to prevent coronary artery ectasia?

• Prevent diseases such as hypertension and hyperlipidemia. If these conditions occur, seek active treatment to avoid atherosclerosis.
• Maintain a balanced diet and avoid irregular routines and unhealthy habits.
• Increase physical activity, control weight, and improve cardiopulmonary function.
• Quit smoking and limit alcohol consumption.
• For children with Kawasaki disease, if medical professionals identify multiple high-risk factors for coronary artery ectasia during treatment, close attention and aggressive intervention are necessary. Managing coronary artery damage in these patients can effectively reduce the incidence of coronary artery ectasia.