Giant right coronary artery aneurysm presenting as an STEMI

Giant coronary artery aneurysms are an infrequent finding. They are typically discovered incidentally, rarely presenting with any symptoms. We present the case of a 72-year-old gentleman who presented with an ST elevated myocardial infarction. On investigation, the gentleman was found to have a giant right coronary artery aneurysm which was partially filled with a fresh thrombus. The thrombus occluded the RCA, triggering the myocardial infarction which leads to this gentleman’s presentation to a tertiary cardiac centre. The gentleman underwent a successful resection of the aneurysm and coronary artery bypass graft over the RCA lesion with a saphenous vein conduit. This gentleman has since been discharged from hospital after an uncomplicated postoperative course.