A dangerous case of colic: anomalous left coronary artery presenting with paroxysms of irritability

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is a rare congenital heart defect.
• It can present as a serious cause of irritability in infants.
• Delayed diagnosis can lead to significant morbidity and mortality.

Observation:

• A 12-week-old male infant presented with prolonged irritability, initially managed as colic.
• Diagnostic workup eventually revealed ALCAPA.
• Review of prior cases indicates irritability paroxysms can be a key symptom.

Findings:

• ALCAPA can manifest with non-specific symptoms like irritability, mimicking common infant conditions such as colic.
• Distinguishing ALCAPA from other causes of infant colic is possible through careful clinical evaluation and diagnostic testing.
• Paroxysmal irritability was a significant feature in this case and in reviewed literature.

Implications:

• Highlights the importance of considering rare congenital heart defects in the differential diagnosis of persistent infant irritability.
• Emphasizes the need for prompt and accurate diagnosis of ALCAPA to prevent severe outcomes.
• Suggests that characteristic clinical features, though sometimes subtle, can help differentiate ALCAPA from infantile colic.