A Cardiogenic Shock due to an Acute MI with LCA Arising from the Right Coronary Sinus Successfully Treated with PCI

Area of Science:

• Cardiology
• Congenital Heart Disease
• Interventional Cardiology

Background:

• Coronary artery anomalies (CAAs) are congenital conditions affecting coronary artery origins.
• The left coronary artery (LCA) originating from the right coronary sinus is exceptionally rare, occurring in 0.03% of cases.
• These anomalies can predispose individuals to myocardial infarction and other cardiac events.

Observation:

• An 85-year-old female presented with cardiogenic shock.
• The patient had an acute anterolateral myocardial infarction due to a totally occlusive lesion in a long left main stem.
• Imaging revealed a complete left coronary artery arising from the right coronary sinus, a very rare CAA.

Findings:

• The rare coronary artery anomaly was directly linked to the acute myocardial infarction and subsequent cardiogenic shock.
• The occlusive lesion in the long left main stem was successfully treated with two drug-eluting stents.
• This case represents a unique presentation of cardiogenic shock secondary to this specific coronary anomaly.

Implications:

• This case highlights the critical importance of recognizing rare CAAs in patients presenting with acute coronary syndromes.
• Management of such anomalies, especially when causing acute ischemia, poses significant challenges in the cardiac catheterization laboratory.
• Successful stenting demonstrates a viable treatment option for acute occlusive lesions in this rare anatomical variant.