Angina in the Young: A Right Coronary Artery Malignant Course - a case report

Background Coronary artery anomalies are rare congenital defects that often remain undetected due to their asymptomatic nature. However, in certain cases, they represent an important cause of sudden cardiac death (SCD), particularly among younger individuals with low to intermediate risk factors for coronary artery disease. Case summary We report the case of a 35-year-old woman who presented to the cardiology outpatient clinic with intermittent typical anginal chest pain. Despite having a low-to-moderate risk profile for ischaemic heart disease, limited to well-controlled hypertension and hypercholesterolaemia, further evaluation with computed tomographic coronary angiography (CTCA) revealed an anomalous right coronary artery (RCA) originating from the left coronary sinus with a malignant course. An exercise stress echocardiogram demonstrated ischaemic electrocardiographic (ECG) changes in the absence of physical symptoms. Her cardiovascular risk factors were managed with medications; however, due to evidence of inducible ischaemia, she was referred to a tertiary Adult Congenital Heart Disease centre for ongoing surveillance and consideration of appropriately timed surgical intervention. Conclusion Although rare, anomalous coronary artery disease may represent a significant cause of angina in younger patients. A thorough clinical history remains essential in identifying this condition and facilitating potentially life-saving management.