{
  "abstract": "Background Coronary artery aneurysms (CAA) are rare vascular abnormalities defined as focal dilations exceeding 1.5 times the diameter of an adjacent normal segment. The leading cause of CAAs in adults is atherosclerosis, though other conditions such as Kawasaki disease, connective tissue disorders, and vasculitis have also been identified as contributing factors. Serious complications of CAAs include thrombosis, rupture, and myocardial infarction. Despite the risk of severe complications, patients with CAAs are often asymptomatic and diagnosed incidentally during imaging for unrelated conditions. Chest pains, such as angina, are often the primary clinical manifestation in symptomatic patients. The presence of a severe mental illness (SMI) poses additional challenges in dealing with patients with cardiovascular disease. Challenges in patient presentation include difficulty recognising symptoms, reduced sensitivity to pain and challenges in communicating physical health concerns. Moreover, patients with an SMI have an increased rate of mortality in cardiovascular disease when compared with the general population, accentuating the importance of optimising care for this subset of patients.Case Report We present the case of a 68-year-old woman who was admitted to the emergency department with haemoptysis. Her past medical history included chronic obstructive pulmonary disease, eczema and schizoaffective disorder. She was transferred from an inpatient mental health unit where she was being treated under Section 3 of the Mental Health Act due to a relapse of psychosis. She was hypoxic, tachycardic and hypertensive, in addition to being agitated and uncooperative with clinical examination. Blood tests showed raised d-dimer and inflammatory markers. A computed tomography pulmonary angiography revealed several concerning findings, most notably an aneurysmal structure located inferior to the right pulmonary artery, measuring 4.2 cm x 2.9 cm (See figure 1). The aneurysm’s exact origin was unclear due to motion artefacts, necessitating further imaging via coronary CT angiography. Several challenges were faced in further investigating and managing the CAA discovery. These resulted from concerns surrounding the patient’s ability to tolerate further investigations, the risk of poor compliance with medical management and the limited capacity for invasive treatments. Following multi-disciplinary team discussions, conservative management was favoured, with anticoagulation therapy initiated. A follow-up chest x-ray demonstrated worsening opacification of the right hemithorax, potentially indicating a lung malignancy. Four weeks later, she was readmitted with worsening dyspnoea due to presumed malignant progression and, unfortunately, passed away.Abstract 2-009 Figure 1Discussion CAAs are a potentially life-threatening cardiovascular condition that can be managed through medical management with anticoagulant therapy or more invasive approaches, including percutaneous coronary intervention and coronary artery bypass grafting. This case underscores the complexity of diagnosing and managing coronary artery aneurysms in patients with severe mental illness. The absence of standardised guidelines for CAAs further complicates management decisions, requiring a case-by-case approach. A holistic, patient-centred approach that integrates psychiatric, cardiovascular and ethical considerations is essential in improving outcomes in this vulnerable population.",
  "authors": [
    {
      "affiliations": [
        "Northern Lincolnshire and Goole NHS Trust"
      ],
      "name": "Leyan Edhem"
    },
    {
      "affiliations": [
        "Northern Lincolnshire and Goole NHS Trust"
      ],
      "name": "Mae Hands"
    },
    {
      "affiliations": [
        "Northern Lincolnshire and Goole NHS Trust"
      ],
      "name": "Gedoni Eni"
    },
    {
      "affiliations": [
        "Northern Lincolnshire and Goole NHS Trust"
      ],
      "name": "Shehnoor Kaur"
    },
    {
      "affiliations": [
        "Northern Lincolnshire and Goole NHS Trust",
        "Academy of Medical Educators",
        "Royal College of Physicians"
      ],
      "name": "Jhiamluka Solano"
    },
    {
      "affiliations": [
        "Northern Lincolnshire and Goole NHS Trust"
      ],
      "name": "Ahmed Adnan"
    }
  ],
  "title": "2-009 Balancing mental health and cardiovascular risk: the challenges of diagnosing and managing coronary artery aneurysms in patients with severe mental illness – a case report",
  "uid": "256f34dd-63f8-55cc-b34b-efbb4d20f4bc"
}