A Case of Anomalous Origin of the Right Coronary Artery from the Left Anterior Descending Artery

Prokopis Papadimitriou, Anastasis Koumoulidis, Dimitris Stalikas


A 34-year-old man, ex-smoker, with family history of coronary artery disease presented to the emergency room complaining of an episode of chest discomfort at rest, radiating to the arms, accompanied with palpitations, that started several hours earlier, lasted for several minutes and resolved with a syncopal episode. He did not mention any prior similar episodes and did not have angina or dyspnea on exertion, orthopnea or paroxysmal nocturnal dyspnea. At the time of presentation he was asymptomatic. His physical examination was unremarkable. However, his electrocardiogram revealed sinus rhythm with mild ST depression and T-wave inversion in leads I, avL, V4-V6. The patient was admitted to the coronary care unit with a possible diagnosis of an acute coronary syndrome. Cardiac markers remained normal in consecutive measurements. His echocardiogram was normal and a 24-hour Holter recording did not reveal any significant arrhythmic events. Coronary angiography was performed for further evaluation of the episode; it displayed normal courses of the left main coronary artery (LMCA), dominant left circumflex (LCX), and left anterior descending artery (LAD). An anomalous right coronary artery (RCA) as a separate small branch arose from the distal LAD with subsequent anterior course (Fig. 1 & 2)... (excerpt)


coronary anomalies; coronary arteries; coronary angiography; acute coronary syndrome

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