View Article PDF

A 21-year-old man was admitted after a ventricular fibrillation cardiac arrest that occurred whilst jogging. Spontaneous circulation was restored after shocks by the paramedic team. He had previously been fit and well with no other medical problems. There was no family history of cardiac problems. Cardiovascular examination was normal but ECG showed ST elevation in leads II, III and aVF. Troponin Ts were elevated, confirming an inferior ST-elevation myocardial infarction.Coronary angiography subsequently revealed an aberrant origin of the right coronary artery arising from the left sinus of Valsalva (Figure 1). This is a rare congenital abnormality, which makes the aberrant artery prone to compression between the aorta and pulmonary artery.1This can cause angina, myocardial infarction and sudden cardiac death, in the absence of atherosclerosis.He underwent surgery for re-implantation of the right coronary artery and has made a full recovery. Figure 1. An axial CT angiogram image at the level of the aortic root, showing the aberrant origin of the right coronary artery from the left sinus of Valsalva (arrow). Also shown are the left main coronary artery (x) and the normal origin of the right coronary artery is shown (star) Learning points Atherosclerosis accounts for the majority of myocardial infarction, even in younger patients. In young, otherwise healthy individuals without risk factors for atherosclerosis, a high clinical suspicion for underlying congenital cardiac abnormalities is essential. Congenital coronary artery anomalies account for approximately 20% of sudden cardiac deaths but may also present with angina or exertional syncope.2 Many are completely asymptomatic.2 There are a wide variety of abnormalities, and CT angiography is useful to clarify the exact anatomy.3 Definitive management involves surgical intervention but this must be balanced against risk, particularly for asymptomatic patients.3

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Laura Preston, Core Medical Trainee, Royal Liverpool University Hospital, United Kingdom; Walid Al-Deeb, Specialist Trainee in Radiology, North Wales Radiology Training Scheme, United Kingdom

Acknowledgements

Correspondence

Dr Laura Preston. Royal Liverpool University Hospital, Prescot Road, Liverpool, L7 8XP, United Kingdom

Correspondence Email

laura.preston@doctors.org.uk

Competing Interests

Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000;35:1493-501.Hong MY, Shin DH, Kwon JH, et al. Anomalous separate origin of left anterior descending coronary artery: presented as acute anterior myocardial infarction. Korean Circ J. 2013;43:408-10.Pe\u00f1alver JM, Mosca RS, Weitz D, Phoon CK. Anomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk. BMC Cardiovasc Disord. 2012;12:83.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 21-year-old man was admitted after a ventricular fibrillation cardiac arrest that occurred whilst jogging. Spontaneous circulation was restored after shocks by the paramedic team. He had previously been fit and well with no other medical problems. There was no family history of cardiac problems. Cardiovascular examination was normal but ECG showed ST elevation in leads II, III and aVF. Troponin Ts were elevated, confirming an inferior ST-elevation myocardial infarction.Coronary angiography subsequently revealed an aberrant origin of the right coronary artery arising from the left sinus of Valsalva (Figure 1). This is a rare congenital abnormality, which makes the aberrant artery prone to compression between the aorta and pulmonary artery.1This can cause angina, myocardial infarction and sudden cardiac death, in the absence of atherosclerosis.He underwent surgery for re-implantation of the right coronary artery and has made a full recovery. Figure 1. An axial CT angiogram image at the level of the aortic root, showing the aberrant origin of the right coronary artery from the left sinus of Valsalva (arrow). Also shown are the left main coronary artery (x) and the normal origin of the right coronary artery is shown (star) Learning points Atherosclerosis accounts for the majority of myocardial infarction, even in younger patients. In young, otherwise healthy individuals without risk factors for atherosclerosis, a high clinical suspicion for underlying congenital cardiac abnormalities is essential. Congenital coronary artery anomalies account for approximately 20% of sudden cardiac deaths but may also present with angina or exertional syncope.2 Many are completely asymptomatic.2 There are a wide variety of abnormalities, and CT angiography is useful to clarify the exact anatomy.3 Definitive management involves surgical intervention but this must be balanced against risk, particularly for asymptomatic patients.3

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Laura Preston, Core Medical Trainee, Royal Liverpool University Hospital, United Kingdom; Walid Al-Deeb, Specialist Trainee in Radiology, North Wales Radiology Training Scheme, United Kingdom

Acknowledgements

Correspondence

Dr Laura Preston. Royal Liverpool University Hospital, Prescot Road, Liverpool, L7 8XP, United Kingdom

Correspondence Email

laura.preston@doctors.org.uk

Competing Interests

Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000;35:1493-501.Hong MY, Shin DH, Kwon JH, et al. Anomalous separate origin of left anterior descending coronary artery: presented as acute anterior myocardial infarction. Korean Circ J. 2013;43:408-10.Pe\u00f1alver JM, Mosca RS, Weitz D, Phoon CK. Anomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk. BMC Cardiovasc Disord. 2012;12:83.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 21-year-old man was admitted after a ventricular fibrillation cardiac arrest that occurred whilst jogging. Spontaneous circulation was restored after shocks by the paramedic team. He had previously been fit and well with no other medical problems. There was no family history of cardiac problems. Cardiovascular examination was normal but ECG showed ST elevation in leads II, III and aVF. Troponin Ts were elevated, confirming an inferior ST-elevation myocardial infarction.Coronary angiography subsequently revealed an aberrant origin of the right coronary artery arising from the left sinus of Valsalva (Figure 1). This is a rare congenital abnormality, which makes the aberrant artery prone to compression between the aorta and pulmonary artery.1This can cause angina, myocardial infarction and sudden cardiac death, in the absence of atherosclerosis.He underwent surgery for re-implantation of the right coronary artery and has made a full recovery. Figure 1. An axial CT angiogram image at the level of the aortic root, showing the aberrant origin of the right coronary artery from the left sinus of Valsalva (arrow). Also shown are the left main coronary artery (x) and the normal origin of the right coronary artery is shown (star) Learning points Atherosclerosis accounts for the majority of myocardial infarction, even in younger patients. In young, otherwise healthy individuals without risk factors for atherosclerosis, a high clinical suspicion for underlying congenital cardiac abnormalities is essential. Congenital coronary artery anomalies account for approximately 20% of sudden cardiac deaths but may also present with angina or exertional syncope.2 Many are completely asymptomatic.2 There are a wide variety of abnormalities, and CT angiography is useful to clarify the exact anatomy.3 Definitive management involves surgical intervention but this must be balanced against risk, particularly for asymptomatic patients.3

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Laura Preston, Core Medical Trainee, Royal Liverpool University Hospital, United Kingdom; Walid Al-Deeb, Specialist Trainee in Radiology, North Wales Radiology Training Scheme, United Kingdom

Acknowledgements

Correspondence

Dr Laura Preston. Royal Liverpool University Hospital, Prescot Road, Liverpool, L7 8XP, United Kingdom

Correspondence Email

laura.preston@doctors.org.uk

Competing Interests

Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000;35:1493-501.Hong MY, Shin DH, Kwon JH, et al. Anomalous separate origin of left anterior descending coronary artery: presented as acute anterior myocardial infarction. Korean Circ J. 2013;43:408-10.Pe\u00f1alver JM, Mosca RS, Weitz D, Phoon CK. Anomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk. BMC Cardiovasc Disord. 2012;12:83.

Contact diana@nzma.org.nz
for the PDF of this article

Subscriber Content

The full contents of this pages only available to subscribers.

LOGINSUBSCRIBE