Anomalous origin of the right coronary artery from the left main coronary artery in a patient with non-specific chest pain

Anomalous origin of the coronary arteries is a rare congenital condition that can present as non-specific chest pain or shortness of breath or remain asymptomatic. Early identification is critical as certain variants are linked with a high risk of sudden cardiac death. Here, we report the case of a 53-year-old female with hypertension, hypothyroidism, obesity (class II) and a history of intermittent chest pain radiating to the left arm for two years. A cardiology workup including ECG, cardiac enzymes, echocardiography and CT coronary angiography revealed an anomalous origin of the right coronary artery (RCA) arising from the left main coronary artery (LMCA) with no haemodynamically significant narrowing. This case highlights the significance of advanced imaging techniques in evaluating atypical chest pain, which can reveal critical congenital anomalies of the coronary arteries. Although this anomaly was not associated with ischaemia in our patient, its recognition is vital for appropriate management and risk stratification.