Case

A 63 year-old male, with no significant medical history, presented with symptoms of severe mid sternal chest burning and pressure associated with dyspnea for 2 hours.He had no history of hypertansion,diabetes mellitus,hyperlipidemia,smoking. He did not have a family history of premature coronary artery disease.Physical examination was unremarkable.Electrocardiography (ECG) on admission showed ST elevation in lead D2-D3-AVF and echocardiography showed inferior hypokinesia and mild mitral regurgitation with % 50 ejection fraction.He was diagnosed acute inferior myocardial infarction and immediately was taken to the catheter laboratory.Coronary angiography showed diffuse severe coronary ectasia (Figure:1-2) with total thrombotic occlusion of the right coronary artery(RCA)(Figure:3). There was also severe stenosis and aneurysm in the mid RCA and slow flow in all epicardial arteries.Balloon dilatation was made over and over and intracoronary tirofiban was administered.TIMI 2 flow was seen. (Figure:4) Because of the huge thrombotic burden and ectasia, coronary stent was not implanted.Tirofiban infusion was continued 48 hours along. The patient was initiated on aspirin, clopidogrel, metoprolol,statin and ACE inhibitor. Rheumatologic work up was normal.Patient had no family history or any physical stigmata of connective tissue disease. No childhood history of Kawasaki’s disease.