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A Coronary Artery Anomaly Presenting as Acute Coronary Syndrome: A Case Report

Mariana S. de A. Chaud, Camila A. Agostinho, Felipe L. Malafaia, Márcio C. Sampaio, Paulo Chaccur, Pedro Gabriel Melo de Barros e Silva ORCID logo, Expedito E. Ribeiro, José Carlos Teixeira Garcia, Valter Furlan, Henrique B. Ribeiro

(Samaritano Paulista Hospital, São Paulo, SP, Brazil)

Am J Case Rep 2021; 22:e931561

DOI: 10.12659/AJCR.931561

BACKGROUND: Coronary artery anomalies (CAAs) are rare congenital malformations with different clinical presentations and pathophysiological mechanisms. These anomalies are frequently the cause of sudden death in young patients. Most CAAs are incidental findings owing to the lack of symptoms; however, they may be associated with acute coronary syndrome in rare cases.
CASE REPORT: We describe the case of a 47-year-old man who presented with a 1-day history of progressive typical chest pain and elevated troponin levels. The patient underwent a coronary angiography, which unveiled the anomalous origin of the left main coronary artery arising from the right coronary artery, with an interarterial course between the ascending aorta and the pulmonary artery, without coronary artery disease. Coronary computed tomography angiography confirmed the CAA and its relationship with the symptoms. An uneventful coronary artery bypass graft was undertaken, and at the 1-year follow-up, the patient was asymptomatic, with a normal stress test.
CONCLUSIONS: This case depicts the presentation of atypical acute coronary syndrome in a young patient with a rare CAA. In such patients, coronary angiography and coronary computed tomography angiography are essential tools to confirm the diagnosis and to determine treatment. Although controversial, in young individuals presenting CAA with an interarterial course, such as the left main coronary artery arising from the right coronary artery, coronary artery bypass graft may be an important treatment option to avoid sudden death in the future.

Keywords: acute coronary syndrome, Coronary Angiography, Coronary Artery Disease, Death, Sudden, Cardiac

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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