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[The right coronary artery with an anomalous origin and pathway and myocardial ischemia]
P Pijoan Rotgé1, N Anguera Ferrando, N Batalla Sahagún
1Servicio de Cardiología, Hospital Sagrat Cor, Barcelona.
Insights
A rare congenital heart anomaly, the right coronary artery originating abnormally within the aorta, caused exertional angina and cardiac ischemia in a 59-year-old man. This anatomical variation, not atherosclerosis, was the cause of his symptoms.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Coronary artery anomalies are rare but can lead to significant cardiovascular events.
- Exertional angina and signs of myocardial infarction necessitate thorough etiological investigation.
Observation:
- A 59-year-old male presented with exertional angina and atrial fibrillation.
- Electrocardiography and scintigraphy revealed inferior myocardial necrosis and anterior ischemia.
- Angiography and MRI identified an abnormally high origin of the right coronary artery with an anomalous intra-aortic course.
Findings:
- The patient's symptoms were attributed to a congenital coronary artery anomaly, specifically an aberrant right coronary artery origin.
- No evidence of coronary atherosclerosis or intracoronary lesions was found, ruling out typical ischemic heart disease.
Implications:
- This case highlights the importance of considering congenital coronary artery anomalies in the differential diagnosis of ischemic heart disease, even in the absence of atherosclerosis.
- Accurate anatomical delineation using advanced imaging is crucial for diagnosis and management planning.
- Understanding these anomalies can guide surgical or interventional strategies to prevent adverse cardiac events.
Abstract:
We present the case of a 59-year-old man, with exertional angina, atrial fibrillation, electrocardiographic and scintigraphic signs of inferior necrosis and anterior ischemia. An abnormally high take off of the right coronary artery, with anomalous intraaortic initial pathway, was objectified in the patient by means of angiography and magnetic resonance imaging. The patient did not have coronary atherosclerosis or intracoronary lesions.