Abstract
A 76-year-old man was admitted with sudden onset chest pain, palpitations and collapse. His ECG showed ventricular tachycardia (Figure 1a) and subsequent troponin was mildly elevated. Coronary angiography appeared to show an anomalous left main stem coronary artery arising from a position near the right coronary sinus (Figure 1b). The vessel is seen to run posterior to a second catheter which has been placed in the right ventricular outflow tract (Figure 1d, black arrow), suggesting an interarterial course. However, it was not possible to identify an acutely ruptured coronary plaque. It was thus unclear whether the troponin rise related to the tachycardia or was the result of genuine infarction.
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