A Case of Exercise-Induced Chest Pain Due to Anomalous Right Coronary Artery

Abstract

A 58-year-old male presented with 6-month history of exertional chest pain on a background of family history of family history of sudden death in brother at the age of 50. He underwent coronary angiogram and subsequent CTCA after positive exercise stress test. There was anomalous anterior origin of right coronary artery arising from left coronary cusp, coursing between the pulmonary artery and aorta without significant coronary stenosis. (Fig. 1). Heart team meeting consensus was that chest pain was due to exercise-induced pulmonary hypertension and patient was offered single coronary artery bypass grafting. Patient is doing well without recurrence of pain at 3 months of follow-up. The clinical outcome for ARCA is most often benign. Exercise induced cyclical compression and distorted slit-like ostium are thought to be mechanism of ischaemia. Patients who have symptoms of ischaemia or arrhythmia warrant more urgent surgical intervention, both for management of symptoms and reduction in risk of sudden cardiac death [[1]Ghosh P.K. Agarwal S.K. Kumar R. Chandra N. Puri V.K. Anomalous origin of right coronary artery from left aortic sinus.J Cardiovasc Surg (Torino). 1994; 35: 65-70PubMed Google Scholar]. This case illustrates the importance of considering ARCA as a differential diagnosis in patients presenting with exercise induced ischaemic chest pain, without any alternative explanations.