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[Myocardial ischemia caused by anomaly at the origin of the left coronary artery]
1Serviço de Cardiologia, Hospital de Bellvitge, Barcelona.
Insights
A 68-year-old man with new-onset angina had normal coronary arteries but an anomalous origin of the left coronary artery. This congenital anomaly, originating from the right Valsalva sinus, caused myocardial ischemia despite no atherosclerosis.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Coronary artery anomalies are rare congenital conditions that can lead to myocardial ischemia.
- Anomalous origin of the coronary arteries is a significant cause of sudden cardiac death in young athletes.
- Early diagnosis and management are crucial for preventing adverse cardiovascular events.
Observation:
- A 68-year-old male presented with new-onset angina and ECG abnormalities suggestive of myocardial ischemia.
- Coronary angiography revealed no significant atherosclerotic lesions.
- The left coronary artery exhibited an anomalous origin, with the left descending artery arising from the right Valsalva sinus and the circumflex artery sharing an ostium with the right coronary artery.
Findings:
- Anomalous origin of the left coronary artery from the right Valsalva sinus.
- Congenital coronary artery anomaly presenting as myocardial ischemia in an adult.
- Absence of obstructive coronary artery disease despite ischemic symptoms.
Implications:
- Congenital coronary artery anomalies should be considered in the differential diagnosis of myocardial ischemia, even in the absence of atherosclerosis.
- Accurate anatomical delineation via coronary angiography is essential for identifying these anomalies.
- Management strategies should be tailored to the specific anomaly and clinical presentation to prevent ischemic events.
Abstract:
The case of a 68 years old man admitted because of angina "de novo" and submitted to coronariography is reported. The rest ECG showed abnormalities of the ST-T suggesting myocardial ischemia. The coronariography showed: No significant atherosclerotic lesions. The left coronary artery had an anomalous origin; the left descending coronary artery originated from an independent ostium located at the right Valsalva sinus, the circumflex artery had its origin at the same ostium as the right coronary artery.