Coronary artery aneurysm is a rare coronary abnormality, usually diagnosed incidentally by coronary angiography. Major causes of coronary aneurysms include coronary ectasia, Kawasaki disease, and atherosclerosis. Most of the discrete coronary aneurysms are of atherosclerotic origin. The incidence of atherosclerotic coronary aneurysms is about 0.2%, and the left main coronary artery is the least frequently involved artery. Only a few cases of left main coronary artery aneurysm have been reported in the literature, and a left main coronary artery aneurysm involving the proximal segments of the left anterior descending and the left circumflex arteries has not been reported previously. The authors describe this finding in a man who presented with worsening exertional angina pectoris. Coronary angiography demonstrated an aneurysm of the distal left main coronary artery extending into the proximal segments of the left anterior descending and the left circumflex arteries. In addition, a significant flow-limiting atherosclerotic lesion was present in the proximal portion of the left anterior descending artery distal to the aneurysm.

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The origination of all three major coronary arteries from three separate ostia in the right sinus of Valsalva is an exceedingly rare coronary anomaly. Few radiographic and clinical details of this anomaly are available in the literature. We describe this anomaly in a patient with acute myocardial infarction who remained asymptomatic until the 8th decade of her life. Atherosclerotic narrowing of the normally originating right coronary artery caused the acute myocardial infarction. Anomalous left anterior descending and left circumflex arteries were free of any significant obstruction.

SummaryBackground: Exercise tolerance is reduced in hypertension. Hypertension affects left ventricular (LV) diastolic filling by causing abnormal relaxation and decreasing compliance.Hypothesis: This study was designed to determine whether worsening of LV diastolic dysfunction during exercise causes decreased exercise tolerance in hypertension.Merhods: Left ventricular diastolic filling parameters were examined at mitral valve by Doppler echocardiography at rest and at peak exercise in hypertensive patients and were compared with those of age-and gender-matched normotensive individuals. Treadmill exercise stress test was performed according to the Bruce protocol and the exercise time was recorded.Results: Exercise time was significantly shorter in the hypertensive group than that in the normotensive group (320 k 29 vs. 446 k 38 s, p 0.03). The hypertensive group demonstrated abnormal relaxation pattern of diastolic mitral inflow at rest, which became pseudonormal at peak exercise (HA velocity ratio, rest 0.86 k 0.06 vs. exercise 1.19 k 0.09, p