A 49-year-old male with an anomalous right coronary artery with an interarterial course presented with an exercise-induced inferior STEMI and was successfully treated with PCI and subsequent CABG.
Case Report (n=1)
Highlights the importance of considering anomalous right coronary artery in patients presenting with exercise-induced myocardial ischemia.
An anomalous right coronary artery (ARCA) is a congenital coronary artery condition in which the right coronary artery (RCA) originates from an abnormal position. The most common locations of an ARCA are the left sinus of the Valsalva (LSV) and the left main coronary artery (LMCA). In this case, a 49-year-old male with hyperlipidemia presented with chest pain radiating to both arms and back after a high-intensity exercise program. Electrocardiogram demonstrated an inferior wall ST-elevation myocardial infarction (STEMI). The patient received thrombolytic therapy and underwent percutaneous coronary intervention on the mid left circumflex artery with initiation of dual antiplatelet therapy. Coronary computed tomography angiography revealed an ARCA origin. The patient was referred to cardiothoracic surgery and subsequently underwent successful coronary artery bypass grafting (CABG) with discharge in stable condition. ARCA is a rare congenital condition that should be considered in patients with myocardial ischemia or sudden cardiac death. Compression of the RCA between the aorta and pulmonary artery in an interarterial course may cause exertional ischemia and lead to sudden death. Furthermore, ARCA is associated with a stenotic ostium and an acute angle of origin. Management options include: Reimplantation of the RCA, CABG, and unroofing of the intramural segment. Our case emphasizes awareness of ARCA in clinical practice and prompt management.
Zaidi et al. (Tue,) conducted a case report in Anomalous right coronary artery presenting as ST-elevation myocardial infarction (n=1). Percutaneous coronary intervention and coronary artery bypass grafting was evaluated. A 49-year-old male with an anomalous right coronary artery with an interarterial course presented with an exercise-induced inferior STEMI and was successfully treated with PCI and subsequent CABG.