Abstract
Congenital coronary artery anomalies occur in less than 1% of the general population with clinical consequences ranging from benign incidental findings to sudden cardiac death. More often than not this diagnosis is made on a postmortem examination but up to one third of the patients have symptoms such as exertional chest pain and dyspnea. Due to the correctable nature of this entity and the fact that anomalous origins of coronary arteries can be readily diagnosed by noninvasive cardiac imaging modalities, timely clinical suspicion based on symptoms is critical. We present a case of a 37 years old with exertional chest pain and dyspnea of several years duration who was found to have an anomalous origin of the left main coronary artery. A surgical correction was undertaken which resulted in resolution of his symptoms. Our case highlights the importance of keeping congenital coronary anomalies on the differential diagnosis for exertional chest pain and dyspnea in young individuals and following inconclusive noninvasive testing with more definitive diagnostic modalities.
Highlights
Amongst the congenital coronary anomalies, anomalous origin of left main coronary artery from the right coronary sinus is most commonly associated with sudden cardiac death [1]
Congenital coronary anomaly is a known cause of sudden cardiac death in young individuals especially in athletes [3]
Among the congenital coronary malformations, a left main coronary artery arising from right coronary cusp with an intramural course has the highest risk of sudden cardiac death [1,3]
Summary
Amongst the congenital coronary anomalies, anomalous origin of left main coronary artery from the right coronary sinus is most commonly associated with sudden cardiac death [1]. This is more commonly an autopsy finding, up to one third of the patients can have symptoms like exertional chest pain, syncope and dyspnea prior to the fatal event [2]. We report a case of a young non-athlete individual who had similar symptoms which went undiagnosed for a few years because of the normal or inconclusive screening tests like exercise electrocardiography and echocardiography. As most of the anomalies are amenable to surgical correction, timely diagnosis based on clinical suspicion is very important
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