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Diffuse Coronary Artery Ectasia Post-Mortem Study; A Case Report
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Hamid Reza Eftekhari1    , Fereydoun Ashrafiyan Bonab2 , Mehrdad Setareh2 , Fariborz Ashrafi2 , Mohammad Tofighifard2 |
1- General Department of Forensic Medicine of East Azerbaijan Province, Tabriz, Iran , dr.hr.eftekhari@gmail.com
2- General Department of Forensic Medicine of East Azerbaijan Province, Tabriz, Iran |
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Abstract: (66 Views) |
Introduction: Sudden cardiac death (SCD) refers to an unexpected fatal event occurring within one hour of symptom onset and ranks among the leading causes of cardiac mortality worldwide, particularly in Western countries. Despite an overall decline in SCD incidence due to advances in prevention and treatment, uncommon etiologies such as coronary artery ectasia (CAE) have attracted growing attention. CAE is defined as dilation of a coronary artery segment to more than 1.5 times its normal diameter, which can lead to ischemia, thrombosis, and ultimately sudden death. This study presents a case of SCD in a patient with extensive ectasia of the major coronary arteries and reviews the clinical, pathophysiological, and management evidence for this rare syndrome.
Case Report: A previously healthy 31-year-old man was referred for forensic investigation following sudden death. A comprehensive autopsy including gross examination and full toxicology was performed. Examination findings revealed diffuse dilation and wall thinning of the main coronary arteries, left ventricular hypertrophy, and no significant atherosclerotic plaques. Microscopic analysis showed myocardial fibrosis, medial thickening of small epicardial arteries, and degeneration of smooth muscle cells. Toxicology was negative for illicit drugs or medications. Epidemiological studies report CAE prevalence between 0.3% and 8% in angiographic and autopsy series and emphasize the role of matrix metalloproteinases in arterial degradation and remodeling.
Conclusion: These findings demonstrate that CAE can precipitate fatal ischemia and cardiac arrest even without progressive symptoms. Although rare, coronary ectasia represents a significant risk factor for SCD and should be included in the differential diagnosis of sudden cardiac death. Regular surveillance using cross-sectional imaging, functional cardiac assessment for high-risk patients, and the development of guidelines for combined antiplatelet and anticoagulant therapy are essential. |
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| Keywords: Death, Sudden, Cardiac, Coronary vessels |
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Type of Article: Case Report |
Subject:
Forensic Pathology
Received: 2025/05/22 | Revised: 2025/08/17 | Accepted: 2025/08/16
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