What is coronary artery ectasia?

coronary artery ectasia: widening of the heart

After a heart attack I had an angiogram that revealed I have coronary artery ectasia. What causes this and what does it mean for me?

Dr David Adlam says:

Coronary artery aneurysms or ectasia (CAE) means that there are widened sections in the arteries that supply the heart (as shown in the main image).

These widenings might be located in a small section of artery or they could be interspersed with narrower sections. These wider sections mean, instead of blood flowing smoothly through the arteries, it swirls around and moves down the artery more sluggishly, and is the reason patients with CAE might develop stable angina.

Sluggish blood flow also increases the chance of clots forming inside the coronary artery, which can cause a heart attack. Many worry that CAE could increase the risk of dilated coronary vessels bursting but, unlike aneurysms elsewhere in the body, this is very rare.

It’s not unusual to find milder degrees of ectasia in patients with atherosclerosis (a build-up of fatty material inside the arteries); however, fewer than one per cent of patients have widenings that would be classed as CAE.

We don’t know the cause for the majority of coronary artery ectasia cases.

We don’t know the cause for the majority of CAE cases. There is evidence that some people – including those with connective tissue disorders or rare inflammatory conditions, such as Kawasaki disease – have a genetic predisposition to developing CAE.

CAE tends to go undetected until it causes problems, such as angina or a heart attack. It is diagnosed using a CT scan to assess the heart’s arteries (or picked up in a CT scan performed for another reason), or an angiogram.

Increased risk of blood clotting means patients with CAE are treated with medicines that reduce clotting, such as aspirin, clopidogrel or warfarin. Most patients will need to manage additional factors that might increase their risk of developing atherosclerosis, for example by stopping smoking, lowering cholesterol and controlling blood pressure.

In a small number of cases, the pattern of widenings and narrowings may lead doctors to recommend a stent or bypass surgery.

Image of Dr David Adlam

Meet the expert 

 

Dr David Adlam is an Academic Cardiologist researching coronary artery ectasia at the University of Leicester.