Objective: Coronary anomalies do not generate symptoms, it is incidental findings when performing a coronary angiography in a patient with ischemic heart disease or valvular heart disease. The anomalous origin of the circumflex (LCX) of the right coronary artery (RCA) is one of the common anomalies. We describe a case of CX orifice  arising from right coronary sinus in a ``shotgun`` manner with orifice of RCA and successful percutaneous coronary intervention (PCI). Case Report: In this case, the anomalous incidental finding was the arising of the CX artery in “shotgun” shape with the RCA (separate ostium) in a clinic scenario of anterior ST-segment elevation myocardial infarction wherein the patient received fibrinolytic therapy with alteplase, presenting reperfusion criteria (&qt;50% ST-segment resolution at 60 minutes and relief angina) and then underwent to successful PCI. Conclusion: The ectopic origin of the CX is a well-recognized variant, which is considered the most common coronary anomaly. Although this anomaly is classified as benign and asymptomatic, a few cases of sudden death, myocardial infarction, and angina pectoris in the absence of atherosclerotic lesion have been reported. We shared successful PCI in such coronary anomaly in a patients with ST elevation anterior myocardial infarction.  Such coronary anomalies should be considered as well in patients with STEMI undergoing PCI.

The case of a patient with repetitive syncope episodes with a history of using loperamide at high doses for recreational purposes in search of an effect similar to heroin, is reported. In the diagnostic approach with Holter monitoring, ventricular tachycardia and ventricular fibrillation were evidenced. We also present the treatment of our case and review the literature.

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