engleski

Multicomponent etiology of multiple coronary artery aneurysms: case report

In the etiology of coronary artery aneurysms common causes are atherosclerotic disease (USA) and Kawasaki's syndrome (in the world)1. However, in certain cases one should consider infrequent etiology, for instance pathophysiologycal alteration caused by anticardiolipin antibody (aCL) production with consequentional effects on coagulation processes and blood vessels endothelium2. We are presenting 51 years old patient with coronarographicaly verified multiple coronary aneurysms alternating with stenosis. In anamnesis excerpts hyperlipidemia has been present for many years and hypertension during last 9 years. After coronarographic assesment, orientational workup was done to clarify these extensive pathophisiological findings. Classic risk factors for atherosclerosis, present at this patient, were high levels of triglyceride, total cholesterol, LDL, low levels of HDL plus nicotinism from anamnestic data. Coagulation parameters APTV, PV, INR were regular. Immunological workup was done, and high levels of aCL class IgM (66 U/ml ; normal level 0~10 U/ml ; for antiphospholipid syndrome >40U/ml) were measured in blood. Raised levels of antibodies class IgG are linked to higher risk of deep vein thrombosis and pulmonary embolism, while high levels of antibodies class IgM depict patients in risk of cerebrovascular disease3 and hemolytic anemia (in antiphospholipid syndrome). Regarding the positive findings of aCL in serum of our patient, we also considered anamnestic information of stillbirth 20 years ago, which occured after a normal delivery of the first born child. Past levels of aCL and coagulation abnormalities, are unknown due to lack of medical documentation, as information about hereditary diseases too. From other immunological findings, there were high titers of total IgE (457 kU/L, normal level 0~122 kU/L). Significance of this immunological disbalanace cannot be explained because the patient has no clinical signs of allergic diseases. With this case report we wanted to raise the awareness that patients with a cardiovascular disease could have underlying immunological etiopathogenesis. Such patients will require further immunological controls.

coronary artery aneurysms; anticardiolipin antibody;

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