A Coronary Artery Anomaly Presenting as Acute Coronary Syndrome: A Case Report

Abstract

Patient: Male, 47-year-old Final Diagnosis: Coronary artery anomalies Symptoms: Chest discomfort Medication:— Clinical Procedure: — Specialty: Cardiac Surgery • Cardiology Objective: Congenital defects/diseases Background: Coronary artery anomalies (CAAs) are rare congenital malformations with different clinical presentations and pathophysiological mechanisms. These anomalies are frequently the cause of sudden death in young patients. Most CAAs are incidental findings owing to the lack of symptoms; however, they may be associated with acute coronary syndrome in rare cases. Case Report: We describe the case of a 47-year-old man who presented with a 1-day history of progressive typical chest pain and elevated troponin levels. The patient underwent a coronary angiography, which unveiled the anomalous origin of the left main coronary artery arising from the right coronary artery, with an interarterial course between the ascending aorta and the pulmonary artery, without coronary artery disease. Coronary computed tomography angiography confirmed the CAA and its relationship with the symptoms. An uneventful coronary artery bypass graft was undertaken, and at the 1-year follow-up, the patient was asymptomatic, with a normal stress test. Conclusions: This case depicts the presentation of atypical acute coronary syndrome in a young patient with a rare CAA. In such patients, coronary angiography and coronary computed tomography angiography are essential tools to confirm the diagnosis and to determine treatment. Although controversial, in young individuals presenting CAA with an interarterial course, such as the left main coronary artery arising from the right coronary artery, coronary artery bypass graft may be an important treatment option to avoid sudden death in the future.

The dominant left coronary system occlusion: An ECG dilemma for Emergency physicians

“…Posteriorni IM se najčešće javlja kao komplikacija ili ekstenzija inferiornog IM zbog preklapanja njihove koronarne vaskularizacije. Inferoposteriorni IM uglavnom nastaje zbog okluzije desne koronarne arterije (RCA) koja u 70% slučajeva vaskularizuje inferoposteriorni zid leve komore (LK) [3]. U 10% vaskularizacija te regije može doći iz leve cirkumfleksne grane (LCx), ivičnih grana LCx ili česte varijacije njihovog zajedničkog stabla (M1-M3, poznate kao i obtuse marginal arteries (u nomenklaturi abrevijacija OM1-OM3, često prevođene i kao tupe ivične/marginalne grane).…”

“…U 10% vaskularizacija te regije može doći iz leve cirkumfleksne grane (LCx), ivičnih grana LCx ili česte varijacije njihovog zajedničkog stabla (M1-M3, poznate kao i obtuse marginal arteries (u nomenklaturi abrevijacija OM1-OM3, često prevođene i kao tupe ivične/marginalne grane). U preostalih 20% vaskularizacija je kodominantna [3]. EKG manifestacija inferoposteriornog IM će pored klasičnih ST elevacija inferiornih odvoda imati i depresiju ST segmenata V1-V3 odvoda što predstavlja ‶sliku u ogledalu‶ elevacije posteriornih odvoda.…”

“…EKG je zlatni standard lokalizovanja mesta infarkcije, a poznavanjem vaskularizacije segmenata srca može se pretpostaviti i koji koronarni krvni sud je okludiran, što je od važnosti pre obavljanja invazivnih procedura kao što je koronarna angiografija i pripreme na moguće komplikacije. RCA je svojim granama kod 70% ljudi odgovorna za vaskularizaciju inferoposteriornog dela LK, međutim, kada je dominantan sistem LCA, vaskularizacija za taj deo srca dolazi iz LCx, odnosno varijacija njenih grana (OM1-OM3 ili varijacije zajedničkog stabla) [3]. Okluzija levog sistema koronarne vaskularizacije, ima lošiju prognozu kod inferiornog IM od okluzije u češćem desno-dominantnom sistemu [10].…”