Coronary arterial spasm in single right coronary artery

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Coronary artery anomalies are rare congenital conditions that can predispose individuals to various cardiovascular issues.
• Syncope, or fainting, can be a symptom of underlying cardiac pathology, including coronary artery abnormalities.
• Advanced imaging techniques like dual-source computed tomography (DSCT) angiography are crucial for diagnosing complex coronary artery variations.

Observation:

• A 32-year-old male presented with recurrent syncope and pre-syncope.
• Coronary angiography and DSCT angiography revealed an anomalous single right coronary artery.
• A significant branch arose from the proximal single right coronary artery, coursed anterior to the pulmonary artery, and bifurcated into the left anterior descending and circumflex arteries.

Findings:

• The patient exhibited a rare single coronary artery originating as a large right coronary artery.
• The anomalous vessel supplied territory typically supplied by the left coronary system.
• Syncope episodes were attributed to potential coronary artery spasm.

Implications:

• This case highlights the importance of recognizing rare coronary artery anomalies during routine investigations.
• Early diagnosis and appropriate management, such as anti-spasmodic medication (diltiazem), can effectively treat symptoms like syncope associated with coronary anomalies.
• DSCT angiography is a valuable tool for delineating complex coronary artery anatomy and guiding clinical management.