Key result
MDCT angiography detects anomalous left coronary artery in exertional syncope, enabling curative surgery.
Why the study?
Coronary artery anomalies may be overlooked in patients with exercise-induced syncope, and non-invasive diagnostic tools are needed to establish diagnosis and guide treatment.
Case Report (n=1)
MDCT coronary angiography is a useful non-invasive tool for diagnosing congenital coronary artery anomalies in patients with exercise-induced syncope when routine stress tests are unrevealing.
MDCT may aid anomaly detection in select syncope cases; single case report leaves open need for prospective validation.
A 17-year-old man underwent clinical evaluation of exercise-induced syncope. Routine exercise stress test did not show any myocardial ischaemic changes or arrhythmias on the ECG recording. However, multidetector CT (MDCT) angiography of the coronary arteries revealed an abnormal origin of the left coronary artery from the right coronary sinus. The participants' symptoms were diagnosed as cardiogenic syncope possibly due to transient stenosis of the left main coronary artery caught between the functionally distended aortic root and the pulmonary trunk during exercise. After successful patch coronary angioplasty, his symptoms disappeared completely even during a similar degree of strenuous exercise. It is important for clinicians not to overlook possible coronary artery anomalies during management of patients with exercise-induced syncope. MDCT coronary angiography may be a useful and non-invasive tool to establish diagnosis and a surgical approach to rectify congenital coronary artery anomalies.
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Ishisone et al. (2014) conducted a case report in Exercise-induced syncope and anomalous origin of coronary artery (n=1). Multidetector CT (MDCT) angiography was evaluated on Diagnosis of anomalous origin of coronary artery and symptom resolution. Multidetector CT angiography successfully diagnosed an anomalous origin of the left coronary artery in a 17-year-old man with exercise-induced syncope, leading to curative surgical intervention.
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