Abstract
Coronary artery anomalies (CAAs) are congenital disorders with multiple variations in the number, shape, and location of the Ostia of the coronary arterial system. The congenitally absent left main coronary artery (LMCA) is a rare anomaly that can present with benign or fatal complications ahead in life. Diagnosis and management of CAAs are sometimes challenging in low-risk patients.We present a unique case report of a 69-year-old Hispanic female who presented to the hospital with exercise-induced arrhythmia and angina symptoms. The patient complained of several episodes of chest pain, dizziness, and palpitations for a duration of two months. Electrocardiogram (EKG) and nuclear stress tests were equivocal. The angiogram revealed the separate origin of the left anterior descending artery (LAD) and left circumflex coronary artery (LCX) from the left coronary sinus. This anomaly should be considered in differentials when evaluating patients with angina symptoms.Congenital absence of LMCA is a rare condition that remains asymptomatic in the majority of the cases. It can present with exertional chest pain, palpitations, syncope, and sudden cardiac death (SCD). Occurrences of angina and arrhythmia should be carefully evaluated, and symptoms should be followed up closely. A coronary angiogram and electrophysiological testing can assist in the diagnosis.
Highlights
Coronary artery anomalies (CAAs) are congenital disorders characterized by multiple variations in the number, shape, and location of the Ostia of the coronary arteries
We present a unique case report of a 69-year-old Hispanic female who presented to the hospital with exercise-induced arrhythmia and angina symptoms
Congenital absence of left main coronary artery (LMCA) is a rare condition that remains asymptomatic in the majority of the cases
Summary
Coronary artery anomalies (CAAs) are congenital disorders characterized by multiple variations in the number, shape, and location of the Ostia of the coronary arteries. It can present with a wide variety of symptoms such as chest pain, myocardial infarction, arrhythmias, sudden death, syncope, and congestive heart failure. Detection of such an anomaly is of great significance as it can help to prevent serious complications. Our patient was an unusual case of congenital absence of the left main coronary artery (LMCA) who presented with angina symptoms (Video 1). The patient had normal myocardial perfusion images on the nuclear stress test (Figure 2), but because of equivocal EKG changes, the patient underwent cardiac catheterization.
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