Ventricular Tachycardia due to Anomalous Origin of Right Coronary Artery

Abstract

Coronary anomalies are observed in 0.8 to 1% of patients on angiography and about 8% of these occur in Right coronary artery (RCA). Anomalous origin of RCA from left coronary sinus (AORCALS) can cause myocardial ischemia, arrhythmia, syncope and sudden cardiac death (SCD). We report a case of AORCALS presenting as exercise induced ventricular tachycardia (VT). A 48 year old Afro-American female with no known cardiac history presented with exertional palpitations and associated atypical exertional chest pain for couple of months. Dobutamine stress echocardiogram showed normal left ventricular structure and systolic function with mild reversible inferior wall ischemia. An event monitor revealed non sustained monomorphic ventricular tachycardia (VT). Coronary angiogram revealed RCA originating from the left coronary cusp without any significant luminal stenosis. . Further evaluation of RCA course with cardiac CT angiography or MRI was recommended. She declined any further invasive testing or treatment. Age less than 30 is more frequently associated with SCD. Sudden cardiac death is more common when aberrant coronary artery is dominant. We report the first case where ANRCA presents as exercises induced ventricular tachycardia. In our patient, compression of RCA between the great vessels was suspected. Any young patient presenting with ventricular arrhythmias or angina without cardiac risk factors should be considered for coronary anomalies. Young symptomatic patients should be considered for definitive treatment to prevent SCD.