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Coexistence of myocardial infarction with normal coronary arteries and a left circumflex artery anomaly originating from the right coronary artery with a bridge in the left anterior descending artery.

Selcoki Y, Er O, Eryonucu B - Clinics (Sao Paulo) (2009)

View Article: PubMed Central - PubMed

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Congenital anomalies in the origin, course or distribution of the epicardial coronary arteries are found in 1 to 2 percent of the population... Asymptomatic coronary artery anomalies are generally diagnosed incidentally by routine coronary angiography or during autopsy... Approximately 80% of congenital anomalies of the coronary arteries are benign, while 20% of coronary artery anomalies produce life threatening symptoms, including arrhythmias, syncope, myocardial infarction or sudden death... First, he was given 300 mg acetylsalicylic acid orally, followded by 5 mg sublingual isosorbide dinitrate, and finally unfractioned heparin in a 5000 U IV bolus... The patient’s pain was reduced after the injection, but he still had discomfort in his chest... It was supported by the inferior and posteriolateral walls of the left ventricle... No significant fixed stenosis was observed in the coronary arteries... The patient was diagnosed as having an LCX origin anomaly and a myocardial bridge in the LAD... The proximal/retroaortic portion of the anomalous LCX is more likely to develop obstructive atherosclerotic disease than other coronary vessels... Potential mechanisms explaining this finding include altered flow patterns in such vessels due to angulated take off from the aortic sinus and a subsequent tortuous route that predisposes to atherosclerosis., Moreover, Samarendra et al. reported an earlier and greater degree of atherosclerotic narrowing of the anomalous artery as compared to the other coronary arteries in the same patients, as well as to nonanomalous circumflex arteries of age- and gender-matched control subjects with similar clinical characteristics... Some studies have revealed a successful coronary thrombolysis with streptokinase or tissue plasminogen infusion that showed normal coronary arteries on angiography., Possible mechanisms of myocardial infarctions with normal coronary arteries could include spasms of the coronary artery, coronary endothelial damage due to smoking, hypercoagulable states, coronary thrombosis or embolism., Other predisposing factors, such as this case of altered flow patterns related to retroaortic portion anomalous LCX and a muscular bridge, make it very hard to find the etiologic reason(s) of an infarction... We suggest that this case occurred due to thrombosis due to endothelial damage by smoking, and also due to spasms of the anomalous LCX... After early antithrombotic and fibrinolytic therapy, the patient’s pain was reduced but continued.

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Coronary angiography from the left lateral view, not showing the circumflex artery.
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f2-cln64_7p707: Coronary angiography from the left lateral view, not showing the circumflex artery.

Mentions: After two days, the patient underwent coronary angiography using the standard right femoral Judkins technique. The left coronary angiogram showed that one artery arose from the left sinus of valsalva and continued as a single LAD. No obvious LCX was demonstrated, even after taking repeated coronary angiograms With several different views (Figure 2). The angiogram showed the characteristic focal myocardial bridge in the mid LAD. The RCA was normally, originating from the right sinus of valsalva. It was a dominant RCA that ascended the posterior atrioventricular free groove beyond the crux. The LCX originated from the proximal part of the RCA (Figure 3). It was supported by the inferior and posteriolateral walls of the left ventricle. No significant fixed stenosis was observed in the coronary arteries. A significant narrowness in systole was seen at the midportion of the LAD, where the myocardial bridge was observed.


Coexistence of myocardial infarction with normal coronary arteries and a left circumflex artery anomaly originating from the right coronary artery with a bridge in the left anterior descending artery.

Selcoki Y, Er O, Eryonucu B - Clinics (Sao Paulo) (2009)

Coronary angiography from the left lateral view, not showing the circumflex artery.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710446&req=5

f2-cln64_7p707: Coronary angiography from the left lateral view, not showing the circumflex artery.
Mentions: After two days, the patient underwent coronary angiography using the standard right femoral Judkins technique. The left coronary angiogram showed that one artery arose from the left sinus of valsalva and continued as a single LAD. No obvious LCX was demonstrated, even after taking repeated coronary angiograms With several different views (Figure 2). The angiogram showed the characteristic focal myocardial bridge in the mid LAD. The RCA was normally, originating from the right sinus of valsalva. It was a dominant RCA that ascended the posterior atrioventricular free groove beyond the crux. The LCX originated from the proximal part of the RCA (Figure 3). It was supported by the inferior and posteriolateral walls of the left ventricle. No significant fixed stenosis was observed in the coronary arteries. A significant narrowness in systole was seen at the midportion of the LAD, where the myocardial bridge was observed.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Congenital anomalies in the origin, course or distribution of the epicardial coronary arteries are found in 1 to 2 percent of the population... Asymptomatic coronary artery anomalies are generally diagnosed incidentally by routine coronary angiography or during autopsy... Approximately 80% of congenital anomalies of the coronary arteries are benign, while 20% of coronary artery anomalies produce life threatening symptoms, including arrhythmias, syncope, myocardial infarction or sudden death... First, he was given 300 mg acetylsalicylic acid orally, followded by 5 mg sublingual isosorbide dinitrate, and finally unfractioned heparin in a 5000 U IV bolus... The patient’s pain was reduced after the injection, but he still had discomfort in his chest... It was supported by the inferior and posteriolateral walls of the left ventricle... No significant fixed stenosis was observed in the coronary arteries... The patient was diagnosed as having an LCX origin anomaly and a myocardial bridge in the LAD... The proximal/retroaortic portion of the anomalous LCX is more likely to develop obstructive atherosclerotic disease than other coronary vessels... Potential mechanisms explaining this finding include altered flow patterns in such vessels due to angulated take off from the aortic sinus and a subsequent tortuous route that predisposes to atherosclerosis., Moreover, Samarendra et al. reported an earlier and greater degree of atherosclerotic narrowing of the anomalous artery as compared to the other coronary arteries in the same patients, as well as to nonanomalous circumflex arteries of age- and gender-matched control subjects with similar clinical characteristics... Some studies have revealed a successful coronary thrombolysis with streptokinase or tissue plasminogen infusion that showed normal coronary arteries on angiography., Possible mechanisms of myocardial infarctions with normal coronary arteries could include spasms of the coronary artery, coronary endothelial damage due to smoking, hypercoagulable states, coronary thrombosis or embolism., Other predisposing factors, such as this case of altered flow patterns related to retroaortic portion anomalous LCX and a muscular bridge, make it very hard to find the etiologic reason(s) of an infarction... We suggest that this case occurred due to thrombosis due to endothelial damage by smoking, and also due to spasms of the anomalous LCX... After early antithrombotic and fibrinolytic therapy, the patient’s pain was reduced but continued.

Show MeSH