Abstract 8918: Nstemi in a Patient With Anomalous Coronary Artery Origin

Abstract

Introduction: Anomalous origin of the coronary arteries is a rare condition that can be life threatening. We present the case of a patient with anomalous right coronary artery (RCA) origin who presented with atypical chest pain. Case Presentation: A 34-year old man with no medical history presented with atypical chest pain. Initial vital signs were within normal limits and physical examination was unremarkable. Laboratory results revealed a peak troponin of 16.56 Ng/ml and EKG did not show ischemic changes. Echocardiogram demonstrated mildly impaired right ventricular systolic function. Cardiac catheterization showed patent coronaries and anomalous RCA arising from the left coronary cusp (LCC). Cardiac CT showed anomalous origin of the RCA extending from the LCC and coursing between the aorta and the pulmonary artery. Patient remained asymptomatic and was referred for surgical evaluation Discussion: Anomalous RCA originating from the LCC occurs in 0.05%-0.1% of the general population. It may run posterior to the aorta, anterior to the pulmonary trunk, septal or between the pulmonary artery and the aorta itself, like in the case of our patient. Diagnosis of these anomalies can be done by cardiac MRI, cardiac coronary CT, or coronary angiography. Management depends on the nature of the anomalies and remains controversial. Options include coronary angioplasty, conservative medical management, or surgical correction. In patients with intramural course and symptoms of myocardial ischemia, most literature recommends surgical intervention. Conclusions: This case illustrates a unique case of a patient with an anomalous coronary artery origin presenting with NSTEMI. Management can be challenging, and it must be individualized.