Case report: Multiple coronary artery ectasia with left main coronary artery involvement in a patient with history of anabolic steroid use
Tóm tắt
Background
Coronary artery ectasia (CAE) or aneurismal coronary artery disease (CAD) is dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal coronary artery. This form of atherosclerotic coronary artery disease (CAD) can be found in 1.4-4.9% of all coronary angiography patients1. All three coronary vessels can be affected, but almost 75% of patients will have an isolated artery that is ectatic. In a single observational study involving approximately 5,000 patients, CAE was reported mostly in proximal-mid right coronary artery (68%), followed by proximal left anterior descending artery in 60% of cases, and left circumflex artery in 50% of the cases. Left main coronary artery ectasia (LMCA) is an extremely rare occurrence, which accounts for 0.1% of cases1.
Atherosclerosis is the most frequent etiopathogenetic mechanism. Other possible causes include systemic inflammatory vasculitis, connective tissue disorders, genetic diseases, infections, and iatrogenic injury following percutaneous coronary intervention (PCI).
Anabolic steroids are synthetic derivatives of the male sex hormone testosterone. It is used to enhance athletic performance, induce muscle hypertrophy, and augment male sexual characteristics4. It is used by bodybuilders and athletes, but non-athletes also use them in order to improve their physical abilities and appearance. Its use is associated with a wide range of side effects and potential cardiovascular complications. Anabolic steroid was linked to lipid metabolism derangements, hypertension, coagulation disorders, and cardiomyopathy4. Based on the study conducted by Perry et
Methods
This is a case report of 50-year-old male apparently well with no comorbidities who presented with heart failure symptoms. He had a history of anabolic steroid use two years prior to the onset of symptoms. Coronary angiography revealed multiple coronary artery ectasia with left main coronary artery involvement and dilated cardiomyopathy.
Results
This is a report a of 50-year-old male with no history of hypertension, diabetes, kidney disease or childhood illness who presented with shortness of breath, bipedal edema and chest pain. He had a history of anabolic steroid use two years prior to the onset of symptoms. Coronary angiography revealed multiple coronary artery ectasia with left main coronary artery involvement and dilated cardiomyopathy. Three years after stopping the anabolic steroid use repeat 2D Echocardiogram showed concentric left ventricular remodelling, normal wall motion and contractility, adequate systolic function with EF of 68% by Teicholz, 69% by Simpsons, normal left and right atria, normal ventricular size with normal systolic function, normal size main pulmonary artery, aortic root, visualized proximal ascending aorta, and aortic arch dimension. The objective of this case report is to present a rare case of multiple coronary artery ectasia with involvement of left main coronary artery and cardiomyopathy in a patient with history of anabolic steroid use.
