Background: The right coronary artery (RCA) plays a crucial role in providing innervation to the right ventricle and right atrium, including key nodes involved in heart rhythm regulation. Anomalous origin of the RCA, particularly from the left coronary sinus, termed malignant RCA, is a rare congenital condition. Similarly, abnormalities involving the left circumflex artery (LCX), which supplies blood to the lateral and posterior walls of the left ventricle, can also pose significant clinical risks, particularly in cases where the LCX is anomalously connected or obstructed. Given the rarity of these conditions, we report three cases of hospitalized adults with malignant courses of their coronary arteries (two RCAs and one LCX). Case report Case 1: A 53-year-old male with diabetes presented with severe chest pain persisting for 3 days. Diagnostic tests revealed ST segment elevation in inferior leads on electrocardiogram (ECG) and elevated troponin T levels. Coronary angiography revealed an anomalous RCA origin, along with significant occlusion and stenosis in other coronary arteries, indicating a malignant course. The patient underwent coronary revascularization and was scheduled for coronary artery bypass grafting (CABG). Case 2: A 69-year-old female with multiple comorbidities, including diabetes and hypertension, presented with continuous chest pain. ECG indicated left bundle branch block (LBBB), and troponin T levels were elevated. Imaging confirmed a malignant course of the RCA with calcification atheromatous plaque. Despite diagnosis, the patient declined intervention. Case 3: A 76-year-old male presented with chest pain following a road traffic accident where he sustained impact to his chest. Initial tests showed an abnormal ECG and elevated troponin, prompting further investigation. Imaging revealed a sternal fracture and pericardial fluid but no major cardiac events. A coronary CT scan uncovered several significant coronary artery abnormalities, including a calcified obtuse marginal artery, a hypoplastic aberrant left anterior descending artery, and an abnormal left circumflex artery. Conclusion: These cases highlight the clinical challenges posed by anomalous coronary arteries and underscore the importance of timely diagnosis and management. Treatment strategies should be tailored considering individual patient factors and preferences, with a focus on optimizing outcomes and improving quality of life.
Dehnah et al. (Thu,) studied this question.