Syncope in a Patient With Giant Left Main Coronary Aneurysm: Is There a Link With Ventricular Arrhythmias?

Abstract

Giant aneurysm of the left main coronary artery is exceedingly rare and accounts for less than 2% of patients undergoing coronary angiography. The etiology varies depending on the patient's age and geographic area, but half are of atherosclerotic origin. In most cases, coronary aneurysms are asymptomatic, however, symptomatic patients present with symptoms characteristic of coronary artery disease such as chest pain (angina pectoris), myocardial infarction, congestive heart failure, and even sudden death. Coronary angiography is considered the gold standard tool to determine the presence or absence of coronary artery disease, and if present, its size and location. Herein, we report a case of giant aneurysm of the left main coronary artery presenting as syncope and documented nonsustained ventricular tachycardia.

Keywords: Coronary aneurysm; cardiogenic syncope; coronary angiography; tachycardia, ventricular.

Fig. 1

Coronary angiograms show A) a large left main coronary artery aneurysm with no evidence of obstructive coronary artery disease (anteroposterior caudal view), and B) a large aneurysm involving the whole left main coronary artery (left anterior oblique caudal view). Supplemental motion images are available for Figures 1A and 1B.

Fig. 2

Coronary angiogram (left anterior oblique view) shows a dominant right coronary artery with no obstructive disease. Slow contrast agent passage is observed. A supplemental motion image is available for Figure 2.