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Strenuous exercise induced syncope due to coronary artery anomaly.

Yavuz V, Cetin N, Tuncer E, Dalgic O, Taskin U, Bilge AR, Tikiz H - Int Cardiovasc Res J (2014)

Bottom Line: Coronary artery anomalies are among the neglected topics in cardiology.Anomalous origin of the left main coronary artery from the right sinus of valsalva is a rare coronary anomaly observed in 0.15% of patients.Patients experiencing exercise induced syncope accompanied by symptoms of coronary ischemia (typically: chest pain, ischemic findings on ECG, and raised cardiac markers) should be referred to diagnostic coronary angiography.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Akhisar State Hospital, Manisa, Turkey.

ABSTRACT
Coronary artery anomalies are among the neglected topics in cardiology. Anomalous origin of the left main coronary artery from the right sinus of valsalva is a rare coronary anomaly observed in 0.15% of patients. During exercise, the distended aorta and pulmonary artery with increased blood flow may squeeze the Left Main Coronary Artery (LMCA) between them. Even though arrhythmias are common causes of syncope, one should also think about aberrant coronary artery in the patients with syncope of unexplained origin. Patients experiencing exercise induced syncope accompanied by symptoms of coronary ischemia (typically: chest pain, ischemic findings on ECG, and raised cardiac markers) should be referred to diagnostic coronary angiography.

No MeSH data available.


Related in: MedlinePlus

(a) Aberrant Left Main Coronary Artery (LMCA) Arising from the Right Sinus of Valsalva (b) Her Right Coronary Artery Was Arising from the Right Sinus of Valsalva Next to the Emergence of LAD through a Separate Ostium
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fig11930: (a) Aberrant Left Main Coronary Artery (LMCA) Arising from the Right Sinus of Valsalva (b) Her Right Coronary Artery Was Arising from the Right Sinus of Valsalva Next to the Emergence of LAD through a Separate Ostium

Mentions: A 64 year old woman experienced syncope (lasting for one minute), accompanied by chest pain 3 - 4 times after streneous exercise last year. She was referred to our clinic for persistent chest pain after her last syncope. She had a blood pressure of 160/80 mmHg with a rapid, regular cardiac rhythm and a grade 1/6 systolic murmur was heard at the apex. Medical history only revealed hypertension treated by a combination of irbesartan + hydroclorothiazide and lercanadipin. The ECG revealed sinus tachycardia at 124 bpm and ST depression in V3 - V6 and DI-AVL derivations (Figure 1a). One hour later, her heart rate was reduced to 69 bpm and ST depressions were completely resolved on the ECG (Figure 1b). She had mild left ventricular concentric hypertrophy with normal systolic function and minimal mitral regurgitation on echocardiography. Besides, she had increased cardiac enzymes with troponin was 3.88 ng/mL (Normal range < 0.04 ng/mL) and CK-MB was 35.4 U/L (Normal range 0 - 25 U/L). Thus, she was referred for diagnostic coronary angiography for acute coronary syndrome. She had an aberrant Left Main Coronary Artery (LMCA) arising from the right sinus of valsalva (Figure 2a). Her right coronary artery was arising from the right sinus of valsalva next to the emergence of Left Anterior Descending (LAD) artery through a separate ostium (Figure 2b).


Strenuous exercise induced syncope due to coronary artery anomaly.

Yavuz V, Cetin N, Tuncer E, Dalgic O, Taskin U, Bilge AR, Tikiz H - Int Cardiovasc Res J (2014)

(a) Aberrant Left Main Coronary Artery (LMCA) Arising from the Right Sinus of Valsalva (b) Her Right Coronary Artery Was Arising from the Right Sinus of Valsalva Next to the Emergence of LAD through a Separate Ostium
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109038&req=5

fig11930: (a) Aberrant Left Main Coronary Artery (LMCA) Arising from the Right Sinus of Valsalva (b) Her Right Coronary Artery Was Arising from the Right Sinus of Valsalva Next to the Emergence of LAD through a Separate Ostium
Mentions: A 64 year old woman experienced syncope (lasting for one minute), accompanied by chest pain 3 - 4 times after streneous exercise last year. She was referred to our clinic for persistent chest pain after her last syncope. She had a blood pressure of 160/80 mmHg with a rapid, regular cardiac rhythm and a grade 1/6 systolic murmur was heard at the apex. Medical history only revealed hypertension treated by a combination of irbesartan + hydroclorothiazide and lercanadipin. The ECG revealed sinus tachycardia at 124 bpm and ST depression in V3 - V6 and DI-AVL derivations (Figure 1a). One hour later, her heart rate was reduced to 69 bpm and ST depressions were completely resolved on the ECG (Figure 1b). She had mild left ventricular concentric hypertrophy with normal systolic function and minimal mitral regurgitation on echocardiography. Besides, she had increased cardiac enzymes with troponin was 3.88 ng/mL (Normal range < 0.04 ng/mL) and CK-MB was 35.4 U/L (Normal range 0 - 25 U/L). Thus, she was referred for diagnostic coronary angiography for acute coronary syndrome. She had an aberrant Left Main Coronary Artery (LMCA) arising from the right sinus of valsalva (Figure 2a). Her right coronary artery was arising from the right sinus of valsalva next to the emergence of Left Anterior Descending (LAD) artery through a separate ostium (Figure 2b).

Bottom Line: Coronary artery anomalies are among the neglected topics in cardiology.Anomalous origin of the left main coronary artery from the right sinus of valsalva is a rare coronary anomaly observed in 0.15% of patients.Patients experiencing exercise induced syncope accompanied by symptoms of coronary ischemia (typically: chest pain, ischemic findings on ECG, and raised cardiac markers) should be referred to diagnostic coronary angiography.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Akhisar State Hospital, Manisa, Turkey.

ABSTRACT
Coronary artery anomalies are among the neglected topics in cardiology. Anomalous origin of the left main coronary artery from the right sinus of valsalva is a rare coronary anomaly observed in 0.15% of patients. During exercise, the distended aorta and pulmonary artery with increased blood flow may squeeze the Left Main Coronary Artery (LMCA) between them. Even though arrhythmias are common causes of syncope, one should also think about aberrant coronary artery in the patients with syncope of unexplained origin. Patients experiencing exercise induced syncope accompanied by symptoms of coronary ischemia (typically: chest pain, ischemic findings on ECG, and raised cardiac markers) should be referred to diagnostic coronary angiography.

No MeSH data available.


Related in: MedlinePlus