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Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature.

Anantha Narayanan M, DeZorzi C, Akinapelli A, Mahfood Haddad T, Smer A, Baskaran J, Biddle WP - Case Rep Cardiol (2015)

Bottom Line: The left coronary artery was found to originate from the right coronary cusp.Per guidelines, our patient received one vessel bypass graft to her anomalous vessel.It is important for clinicians to recognize such presentations of anomalous coronary artery.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, CHI Health Creighton University Medical Center, 601 North 30th Street No. 5800, Omaha, NE 68131, USA.

ABSTRACT
Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV) myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery.

No MeSH data available.


Related in: MedlinePlus

Coronary angiogram showing clear coronaries and anomalous left anterior descending artery originating from the right coronary cusp. RCA: right coronary artery; LAD: left anterior descending artery; PL: posterolateral branch.
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fig3: Coronary angiogram showing clear coronaries and anomalous left anterior descending artery originating from the right coronary cusp. RCA: right coronary artery; LAD: left anterior descending artery; PL: posterolateral branch.

Mentions: A 61-year-old African American female with past medical history of unexplained syncope, refractory hypertension, and untreated obstructive sleep apnea was brought to the emergency room (ER) after she experienced a witnessed syncope and became unresponsive at home. When emergency medical service found the patient at home, the presenting rhythm was ventricular fibrillation (Figure 1) and patient was shocked twice with reversal of spontaneous circulation in less than 4 minutes. She was intubated and was taken to the ER. Her presenting blood pressure in the ER was 120/70 mmHg, and heart rate was 114/min. An electrocardiogram (EKG) showed sinus tachycardia, complete right bundle branch block (RBBB) with left anterior fascicular block (LAFB) and nonspecific ST-T wave changes (Figure 2). A bedside echocardiogram showed normal ejection fraction with severe left ventricular hypertrophy and no regional wall motion abnormalities. Initial labs drawn showed mild hypokalemia of 3.2 meq/L (normal value 3.5–5.5 meq/L), glomerular filtration rate of 47 mL/min/1.73 m2, normal liver function tests, normal complete blood count, and a serum troponin of <0.04 ng/mL (normal value < 0.04 ng/mL). Coronary angiogram (Figure 3) revealed nonobstructive epicardial coronaries with mildly elevated left ventricular end diastolic pressure (LVEDP) of 21 mmHg. The left coronary artery (LCA) was found to originate from the right coronary sinus. Patient was started on hypothermia protocol. Her troponin started to rise peaking at 4.72 ng/mL. Computerized axial tomography (CAT) scan and magnetic resonance imaging (MRI) scan of head and electroencephalogram were normal. Patient achieved complete neurological recovery in three days. Cardiac coronary CAT scan (Figure 4) was obtained that showed anomalous left anterior descending artery (LAD) originating from the right coronary sinus sharing a common ostium with the right coronary artery (RCA). The artery then had an interarterial course between aorta and pulmonary trunk for 1.7 cm followed by an intramural course for 3.3 cm in the interventricular septum and then exited the myocardium for an epicardial course at the level of mid LAD. The intramural caliber measured 2.2 mm in cross section. The left main coronary artery had a normal origin giving rise to left circumflex and ramus intermedius. Patient underwent one vessel coronary artery bypass grafting with left internal mammary artery to the epicardial LAD at the level immediately after its intramural course. Patient then received implantable cardioverter and defibrillator (ICD) for secondary prevention and was discharged home on a stable condition.


Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature.

Anantha Narayanan M, DeZorzi C, Akinapelli A, Mahfood Haddad T, Smer A, Baskaran J, Biddle WP - Case Rep Cardiol (2015)

Coronary angiogram showing clear coronaries and anomalous left anterior descending artery originating from the right coronary cusp. RCA: right coronary artery; LAD: left anterior descending artery; PL: posterolateral branch.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4518180&req=5

fig3: Coronary angiogram showing clear coronaries and anomalous left anterior descending artery originating from the right coronary cusp. RCA: right coronary artery; LAD: left anterior descending artery; PL: posterolateral branch.
Mentions: A 61-year-old African American female with past medical history of unexplained syncope, refractory hypertension, and untreated obstructive sleep apnea was brought to the emergency room (ER) after she experienced a witnessed syncope and became unresponsive at home. When emergency medical service found the patient at home, the presenting rhythm was ventricular fibrillation (Figure 1) and patient was shocked twice with reversal of spontaneous circulation in less than 4 minutes. She was intubated and was taken to the ER. Her presenting blood pressure in the ER was 120/70 mmHg, and heart rate was 114/min. An electrocardiogram (EKG) showed sinus tachycardia, complete right bundle branch block (RBBB) with left anterior fascicular block (LAFB) and nonspecific ST-T wave changes (Figure 2). A bedside echocardiogram showed normal ejection fraction with severe left ventricular hypertrophy and no regional wall motion abnormalities. Initial labs drawn showed mild hypokalemia of 3.2 meq/L (normal value 3.5–5.5 meq/L), glomerular filtration rate of 47 mL/min/1.73 m2, normal liver function tests, normal complete blood count, and a serum troponin of <0.04 ng/mL (normal value < 0.04 ng/mL). Coronary angiogram (Figure 3) revealed nonobstructive epicardial coronaries with mildly elevated left ventricular end diastolic pressure (LVEDP) of 21 mmHg. The left coronary artery (LCA) was found to originate from the right coronary sinus. Patient was started on hypothermia protocol. Her troponin started to rise peaking at 4.72 ng/mL. Computerized axial tomography (CAT) scan and magnetic resonance imaging (MRI) scan of head and electroencephalogram were normal. Patient achieved complete neurological recovery in three days. Cardiac coronary CAT scan (Figure 4) was obtained that showed anomalous left anterior descending artery (LAD) originating from the right coronary sinus sharing a common ostium with the right coronary artery (RCA). The artery then had an interarterial course between aorta and pulmonary trunk for 1.7 cm followed by an intramural course for 3.3 cm in the interventricular septum and then exited the myocardium for an epicardial course at the level of mid LAD. The intramural caliber measured 2.2 mm in cross section. The left main coronary artery had a normal origin giving rise to left circumflex and ramus intermedius. Patient underwent one vessel coronary artery bypass grafting with left internal mammary artery to the epicardial LAD at the level immediately after its intramural course. Patient then received implantable cardioverter and defibrillator (ICD) for secondary prevention and was discharged home on a stable condition.

Bottom Line: The left coronary artery was found to originate from the right coronary cusp.Per guidelines, our patient received one vessel bypass graft to her anomalous vessel.It is important for clinicians to recognize such presentations of anomalous coronary artery.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, CHI Health Creighton University Medical Center, 601 North 30th Street No. 5800, Omaha, NE 68131, USA.

ABSTRACT
Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV) myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery.

No MeSH data available.


Related in: MedlinePlus