When Psychiatry Meets Cardiology: A Case Report on the Challenges of Diagnosing and Managing Cardiovascular Disease in Patients With Severe Mental Illness

Coronary artery aneurysms (CAA) are rare vascular abnormalities defined as focal dilations exceeding 1.5 times the diameter of an adjacent normal segment. 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. The presence of a severe mental illness (SMI) poses additional challenges in dealing with patients with cardiovascular disease. We present the case of a 68-year-old woman who was admitted to the emergency department with hemoptysis, hypoxia, tachycardia, and hypertension in addition to being agitated and uncooperative. A computed tomography pulmonary angiography revealed several concerning findings, most notably an aneurysmal structure located inferior to the right pulmonary artery. 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 favored, and anticoagulation therapy was initiated. This case underscores the complexity of diagnosing and managing coronary artery aneurysms in patients with severe mental illness. The absence of standardized guidelines for CAAs further complicates management decisions, requiring a case-by-case approach. A holistic, patient-centered approach that integrates psychiatric, cardiovascular, and ethical considerations is essential in improving outcomes in this vulnerable population.