Sick Sinus Syndrome Induced by Giant Coronary Artery Aneurysm Rupture in a Patient with Constrictive Pericarditis

Multiple coronary artery aneurysms (CAA) with a giant CAA are rare. Patient with a giant CAA is at risk of thrombosis, aneurysm rupture and even sudden cardiac death. We reported a case of a 78-year-old woman having a giant CAA (43 mm x 37 mm) of proximal left anterior descending artery as well as multiple small CAA of both left and right coronary arteries. The spontaneous rupture of the giant CAA combined with previously undiagnosed constrictive pericarditis leaded to severe dyspnea, edema of lower extremities, and syncope. Emergency electrocardiogram (ECG) showed remarkable sinus bradycardia, sinus arrest and atrioventricular junctional rhythm, indicating sick sinus syndrome. Temporary cardiac pacemaker therapy was performed urgently to avoid sudden cardiac death. Multiple non-invasive imaging tests revealed constrictive pericarditis possibly caused by tuberculosis, and giant CAA with the possibility of rupture. Then pericardiotomy and resection of giant aneurysm were performed urgently. Postoperative course was uneventful. The patient became asymptomatic and was discharged in good health. To the best of our knowledge, this is the first case of spontaneous rupture of giant CAA in a patient with constrictive pericarditis, with a rare complication of sick sinus syndrome.