ACUTE ANTERIOR WALL MYOCARDIAL INFARCTION BY AN ANOMALOUS MID LEFT ANTERIOR DESCENDING ARTERY ORIGINATING FROM THE PROXIMAL RIGHT CORONARY ARTERY

Abstract

SESSION TITLE: Etiologies of Cardiovascular Disease Case Report PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/19/2022 12:45 pm - 01:45 pmINTRODUCTION: The estimated incidence of coronary artery anomalies is up to 1%.CASE PRESENTATION: A 50-year-old man with peripheral artery disease and drug abuse was brought to the emergency department unresponsive post cardiac arrest.Before arrival, he had ventricular fibrillation which progressed to asystole.He received two defibrillations, cardiopulmonary resuscitation, epinephrine, and amiodarone before return of spontaneous circulation. On arrival, he was intubated.EKG showed ST-segment anterior ST-elevations.The patient emergently transported to the cardiac catheterization laboratory.Diagnostic coronary angiography showed a 100% thrombotic stenosis of the second diagonal branch and an anomalous mid and distal LAD originating from the proximal RCA.The D2 was repaired successfully with a 2.5 x 34 mm Resolute Onyx drug-eluting stent.Following decision was made to pursue a dual injection to evaluate for a mid and distal LAD arising as a branch from the conus. Following a 6F JR5 catheter was used to engage the RCA.Dual injections were performed in multiple projections, and a mid and distal LAD arising from the conus was confirmed.At the end of the procedure, the EKG showed resolution of the ST elevations. The patient was transferred to the intensive care unit.DISCUSSION: These anomalies are generally asymptomatic, but rarely may lead to myocardial ischemia/infarction and/or sudden death.In particular, STEMI is a rare clinical presentation and identification of the culprit lesion with subsequent emergent PCI can be challenging in this setting.CONCLUSIONS: We report a rare case of cardiac arrest due to 100% thrombotic occlusion of culprit anomalous LAD originating from RCA leading to acute anterior wall myocardial infarction.Reference #1: Kheirkhah J, Sadeghipour P, Kouchaki A. An anomalous origin of left anterior descending coronary artery from right coronary artery in a patient with acute coronary syndrome. J Tehran Heart Cent. 2011 Nov;6(4):217-9. Epub 2011 Nov 30. PMID: 23074373; PMCID: PMC3467955.DISCLOSURES: No relevant relationships by Samiullah ArshadNo relevant relationships by Huzefa BhopalwalaNo relevant relationships by Nakeya Dewaswalano disclosure on file for Hussam Fawzi Ahmad Hawamdeh;no disclosure submitted for Andrew Leventhal;no disclosure submitted for Adrian Messerli;No relevant relationships by Vinayak Mishra SESSION TITLE: Etiologies of Cardiovascular Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The estimated incidence of coronary artery anomalies is up to 1%. CASE PRESENTATION: A 50-year-old man with peripheral artery disease and drug abuse was brought to the emergency department unresponsive post cardiac arrest. Before arrival, he had ventricular fibrillation which progressed to asystole. He received two defibrillations, cardiopulmonary resuscitation, epinephrine, and amiodarone before return of spontaneous circulation. On arrival, he was intubated. EKG showed ST-segment anterior ST-elevations. The patient emergently transported to the cardiac catheterization laboratory. Diagnostic coronary angiography showed a 100% thrombotic stenosis of the second diagonal branch and an anomalous mid and distal LAD originating from the proximal RCA. The D2 was repaired successfully with a 2.5 x 34 mm Resolute Onyx drug-eluting stent. Following decision was made to pursue a dual injection to evaluate for a mid and distal LAD arising as a branch from the conus. Following a 6F JR5 catheter was used to engage the RCA. Dual injections were performed in multiple projections, and a mid and distal LAD arising from the conus was confirmed. At the end of the procedure, the EKG showed resolution of the ST elevations. The patient was transferred to the intensive care unit. DISCUSSION: These anomalies are generally asymptomatic, but rarely may lead to myocardial ischemia/infarction and/or sudden death. In particular, STEMI is a rare clinical presentation and identification of the culprit lesion with subsequent emergent PCI can be challenging in this setting. CONCLUSIONS: We report a rare case of cardiac arrest due to 100% thrombotic occlusion of culprit anomalous LAD originating from RCA leading to acute anterior wall myocardial infarction. Reference #1: Kheirkhah J, Sadeghipour P, Kouchaki A. An anomalous origin of left anterior descending coronary artery from right coronary artery in a patient with acute coronary syndrome. J Tehran Heart Cent. 2011 Nov;6(4):217-9. Epub 2011 Nov 30. PMID: 23074373; PMCID: PMC3467955. DISCLOSURES: No relevant relationships by Samiullah Arshad No relevant relationships by Huzefa Bhopalwala No relevant relationships by Nakeya Dewaswala no disclosure on file for Hussam Fawzi Ahmad Hawamdeh; no disclosure submitted for Andrew Leventhal; no disclosure submitted for Adrian Messerli; No relevant relationships by Vinayak Mishra