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Aneurisma del tronco principal de la arteria coronaria izquierda Descripción de un caso clínico y revisión de tema
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El aneurisma arterial coronario constituye una entidad rara en la población; su incidencia varía entre 1,5% y 5%, siendo más frecuente en hombres. Existe escasa bibliografía acerca de esta patología a pesar de que su estudio se remonta a finales del siglo XVIII. La arteria que se afecta con mayor frecuencia es la coronaria derecha, aproximadamente en 40% de los casos. La dificultad al momento del diagnóstico clínico radica en que inicialmente el enfoque está dirigido a confirmar y tratar de manera oportuna el síndrome coronario agudo que con insistencia constituye la manifestación inicial con que cursan este tipo de pacientes; por ello el diagnóstico necesariamente requiere ayudas imaginológicas e intervencionistas, o ambas. Hay muchas causas que puedan producir aneurismas en la circulación coronaria, la más común de ellas es la aterosclerosisseguida por trastornos congénitos, enfermedades del tejido conectivo, vasculitis y consumo de cocaína entre otros. Recientemente se han publicado innovadores estudios respecto a la fisiopatología y los avances en terapéutica farmacológica e intervencionista, aunque el tratamiento debe enfocarse en los factores de riesgo, las patologías y las manifestaciones clínicas que presente el paciente. PALABRAS CLAVE: aneurisma arterial coronario, aneurisma sacular, aneurisma fusiforme, ectasia coronaria, isquemia miocárdica, cocaína, enfermedad de Kawasaki, síndrome coronario agudo, arterioesclerosis.
Coronary artery aneurysm is a rare entity in the population. Its incidence rates vary between 1.5% 5%, and is more frequent in males. There is limited literature on this disease, although its study goes back to the late eighteenth century. The most frequently affected artery is the right coronary artery, in approximately 40% of cases. The initial diagnostic difficulty lies in the fact that the initial approach is focused in confirming and treating properly the coronary acute syndrome, which is the most frequent initial presentation in these patients. Therefore, its diagnosis requires necessarily imaging or interventionist aid, or both. Many causes account for coronary aneurysms, being the most common atherosclerosis followed by congenital abnormalities, connective tissue diseases, vasculitis and cocaine consumption. Novel studies regarding the physiopathology and advances in pharmacological and interventionist therapy have been published, although treatment must focus on risk factors, associated pathologies and clinical manifestations. KEY WORDS: coronary artery aneurysm, sacular aneurysm, fusiform aneurysm, coronary ectasia, myocardial ischemia, cocaine, Kawasaki disease, acute coronary syndrome, atherosclerosis. 5HY&RORPE&DUGLRO )XQGDFLyQ6DQWD)HGH%RJRWi%RJRWi&RORPELD &RUUHVSRQGHQFLD 'U -XOLR &pVDU 5RGUtJXH] *R\HV )XQGDFLyQ 6DQWD )H GH %RJRWi 'HSDUWDPHQWRGH0HGLFLQD,QWHUQD&DOOH 1R%RJRWi'&&RORPELD7HOpIRQRV )D[ $$&RUUHRHOHFWUyQLFR MXOOLXVF#\DKRRFRPP[ 5HFLELGR $FHSWDGR
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Tabla 1. ANEURISMA ARTERIAL CORONARIO, INCIDENCIA Y SITIO ANATÓMICO Autores
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El aneurisma arterial coronario constituye una entidad rara en la población; su incidencia varía entre 1,5% y 5%, siendo más frecuente en hombres. Existe escasa bibliografía acerca de esta patología a pesar de que su estudio se remonta a finales del siglo XVIII. La arteria que se afecta con mayor frecuencia es la coronaria derecha, aproximadamente en 40% de los casos. La dificultad al momento del diagnóstico clínico radica en que inicialmente el enfoque está dirigido a confirmar y tratar de manera oportuna el síndrome coronario agudo que con insistencia constituye la manifestación inicial con que cursan este tipo de pacientes; por ello el diagnóstico necesariamente requiere ayudas imaginológicas e intervencionistas, o ambas. Hay muchas causas que puedan producir aneurismas en la circulación coronaria, la más común de ellas es la aterosclerosisseguida por trastornos congénitos, enfermedades del tejido conectivo, vasculitis y consumo de cocaína entre otros. Recientemente se han publicado innovadores estudios respecto a la fisiopatología y los avances en terapéutica farmacológica e intervencionista, aunque el tratamiento debe enfocarse en los factores de riesgo, las patologías y las manifestaciones clínicas que presente el paciente. PALABRAS CLAVE: aneurisma arterial coronario, aneurisma sacular, aneurisma fusiforme, ectasia coronaria, isquemia miocárdica, cocaína, enfermedad de Kawasaki, síndrome coronario agudo, arterioesclerosis.
Coronary artery aneurysm is a rare entity in the population. Its incidence rates vary between 1.5% 5%, and is more frequent in males. There is limited literature on this disease, although its study goes back to the late eighteenth century. The most frequently affected artery is the right coronary artery, in approximately 40% of cases. The initial diagnostic difficulty lies in the fact that the initial approach is focused in confirming and treating properly the coronary acute syndrome, which is the most frequent initial presentation in these patients. Therefore, its diagnosis requires necessarily imaging or interventionist aid, or both. Many causes account for coronary aneurysms, being the most common atherosclerosis followed by congenital abnormalities, connective tissue diseases, vasculitis and cocaine consumption. Novel studies regarding the physiopathology and advances in pharmacological and interventionist therapy have been published, although treatment must focus on risk factors, associated pathologies and clinical manifestations. KEY WORDS: coronary artery aneurysm, sacular aneurysm, fusiform aneurysm, coronary ectasia, myocardial ischemia, cocaine, Kawasaki disease, acute coronary syndrome, atherosclerosis. 5HY&RORPE&DUGLRO )XQGDFLyQ6DQWD)HGH%RJRWi%RJRWi&RORPELD &RUUHVSRQGHQFLD 'U -XOLR &pVDU 5RGUtJXH] *R\HV )XQGDFLyQ 6DQWD )H GH %RJRWi 'HSDUWDPHQWRGH0HGLFLQD,QWHUQD&DOOH 1R%RJRWi'&&RORPELD7HOpIRQRV )D[ $$&RUUHRHOHFWUyQLFR MXOOLXVF#\DKRRFRPP[ 5HFLELGR $FHSWDGR
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Tabla 1. ANEURISMA ARTERIAL CORONARIO, INCIDENCIA Y SITIO ANATÓMICO Autores
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