Case presentation A 53-year-old woman, previously fit and well, presented with a history of exertional chest discomfort radiating to left breast and left arm, with risk factors for coronary artery disease (hypertension and smoking). Figure 2. [bjcardio.co.uk]

A patient presenting with signs and symptoms suggesting myocardial ischemia was found to have anomalous origin of his right coronary artery from the left aortic sinus of valsalva associated with a bicuspid aortic valve. [ncbi.nlm.nih.gov]

Here we would like to attract attention to coronary abnormalies by presenting this case. [openaccessjournals.com]

and Gregory Schuchard, M.D. 4 Citing Articles A 49-year-old man presented for evaluation of palpitations and epigastric and burning pain in the lower chest. [nejm.org]

Clinical Presentation Patients with ALCAPA usually present with symptoms early within the first year of life with chronic ischemia due to this coronary artery malformation leading to congestive heart failure. [omicsonline.org]

• Hyperthermia

  Triggers for perioperative tachycardia including pain, hypovolemia, anemia, hyperthermia, shivering and nausea/ emesis should be avoided or promptly addressed. [www2.ccasociety.org]

• Heart Disease

  Author information 1 Department of Pediatric Cardiology and Adults with Congenital Heart Disease, Meyer Children's Hospital, Rambam Health Care Campus, Box 9602, 31096, Haifa, Israel. [ncbi.nlm.nih.gov]

  The majority of patients with ALCAPA present in early life with symptoms of ischemic heart disease often causing death. [omicsonline.org]

  They are found in approximately 1% of the population undergoing coronary angiography, 1 and are often associated with other structural heart disease. [bjcardio.co.uk]

  CAA is associated with some other congenital heart diseases like tetralogy of Fallot, transposition of great arteries and pulmonary valve atresia. [openaccessjournals.com]

• Continuous Murmur

  In 2, aged 6 and 7 years, the anomaly was of the adult type; the patients were free from symptoms but had continuous murmurs at the left sternal border and mild left ventricular hypertrophy. [jamanetwork.com]

  If a continuous murmur is present, its origin should be defined either by echocardiography, MRI, CT angiography, or cardiac catheterization. ( Level of Evidence: C ) " ” 2. [wikidoc.org]

  A continuous murmur resembling a patent ductus arteriosus with flow from the aorta to the pulmonary circulation can be found reflecting collateral flow. [omicsonline.org]

• Exertional Chest Pain

  A 53-year-old woman presented with history of exertional chest pain. A coronary angiogram subsequently showed an unusual and rare coronary artery anatomy: all of her coronary arteries originate from the right coronary cusp, with separate ostia. [bjcardio.co.uk]

  Due to exertional chest pain suggestive of angina, he underwent cardiac catheterization, which revealed moderate left ventricular dysfunction with an ejection fraction of 30% to 35% and global hypokinesis. [read.nxtbook.com]

• Systolic Murmur

  Case report A healthy, athletic, 25-year-old black man was referred to our institution for evaluation of a short systolic murmur. [mdmag.com]

• Neglect

  The aim of this report is to revise this important but often neglected topic, its clinical implications, and to discuss a rare case that was recently encountered in our hospital. [bjcardio.co.uk]

When ACAOS is identified in this manner, a further workup should include nuclear stress testing. [circ.ahajournals.org]

• Left Axis Deviation

  His electrocardiogram revealed normal sinus rhythm at a rate of 80 beats/min, left axis deviation, left atrial abnormality, and T-wave inversion in lead V 6. [read.nxtbook.com]

• Dyslipidemia

  The second patient (son of the first) is a 50-year-old man, smoker, with dyslipidemia, who underwent coronary angiography to investigate chest pain on exertion. [revespcardiol.org]

• T Wave Inversion

  The resting electrocardiogram demonstrated incomplete right bundle branch block and T wave inversion in the inferior leads. Transthoracic echocardiography revealed no wall motion abnormalities with a normal ejection fraction. [ispub.com]

  His electrocardiogram revealed normal sinus rhythm at a rate of 80 beats/min, left axis deviation, left atrial abnormality, and T-wave inversion in lead V 6. [read.nxtbook.com]

Treatment recommendations from medical experts may vary because there is not yet an agreed-upon “correct” way to treat AAOCA. [chop.edu]

Surgical treatment of coronary artery anomalies: report of a 37 ½-year experience at the Texas Heart Institute. Tex Heart Inst J 2002; 29 :299–307. Available from Further reading Pollock BD, Belkin RN, Lazar S, Pucillo A, Cohen MB, Weiss MB. [bjcardio.co.uk]

Treatment Prior to treatment, assessment of myocardial ischemia is identified by exercise treadmill, 201TI SPECT, or dobutamine stress echocardiography [ 20 ]. [omicsonline.org]

IS MEDICAL TREATMENT AN OPTION? The lack of series and controlled studies makes it difficult to respond to this question. [revespcardiol.org]

Treatment Surgical correction is the gold standard in treating an anomalous origin of the right coronary artery; however, because of the rarity of this condition, there is no consensus on the timing of surgery. [mdmag.com]

The deadliest of pathways, with the worst prognosis, is the inter-arterial course. This is when the LCA makes its course between the aortic root and right ventricular outflow tract (RVOT). [pubs.sciepub.com]

Zheng JY, Han L, Ding WH, Jin M, Zhang GZ, et al. (2010) Clinical features and long-term prognosis of patients with anomalous origin of the left coronary artery from the pulmonary artery. Chin Med J (Engl) 123: 2888-2894. [omicsonline.org]

Clinical features on prognosis of Japanese patients with anomalous origin of the coronary artery. Jpn Circ J. 1996;60:731-41. Medline 69. Corrado D, Basso C, Rizzoli G, Thiene G. [revespcardiol.org]

Only such efforts can give rise to the large-scale studies needed to define the prognosis and optimal treatment of individual forms of CAAs. [circ.ahajournals.org]

The authors concluded that the prognosis of middle-aged to elderly patients with an anomalous origin of the coronary artery is relatively good. [journals.lww.com]

Because acquired etiologic factors were not detected, we believe that the lesions were structural defects of congenital origin. [ncbi.nlm.nih.gov]

Etiology Theories have been described to explain the origin of a coronary artery from the pulmonary trunk specifically related to the embryologic division of the truncus arteriosus. [omicsonline.org]

These anomalies have different clinical and anatomical presentations that still need more studies to know the prevalence, etiology or risk factors and how to screen for such anomalies. [oatext.com]

The prevalence is reported to be 0.002%. 10 Various etiologies are known; they include traumatic, infectious, and iatrogenic causes. The involved fistulous artery is often dilated and tortuous. [appliedradiology.com]

Finocchiaro G, Papadakis M, Robertus JL, et al Etiology of sudden death in sports. Insights from a United Kingdom Regional Registry. JACC 2015;67:2108–15. [14]. [journals.lww.com]

Chugh SS, Reinier K, Teodorescu C, Evanado A, Kehr E, et al. (2008) Epidemiology of sudden cardiac death: clinical and research implications. ProgCardiovasc Dis 51: 213-228. [omicsonline.org]

"rarely" encountered in the general population Epidemiology Coronary anomalies affect 1% of the general population Necropsies yield an even lower incidence (0.3%) According to the Sudden Death Committee of the American Heart Association, coronary anomalies [pathologyoutlines.com]

Epidemiology of congenital coronary artery anomalies: a coronary arteriography study on a central European population. Cathet Cardiovasc Diagn. 1997;42:270-275. Lipton MJ, Barry WH, Obrez I, et al. [read.nxtbook.com]

Kardos A, Babai L, Rudas L et al: Epidemiology of congenital coronary artery anomalies: a coronary arteriography study on a central European population. Cathet Cardiovasc Diagn. 1997 Nov;42(3): 270-275. 7. [ispub.com]

[…] ramifications as well as fistulas from the RCA, LCA, or infundibular artery to the following: Right ventricle Right atrium Coronary sinus Superior vena cava Pulmonary artery Pulmonary vein Left atrium Left ventricle Multiple, right and left ventricles Epidemiology [emedicine.medscape.com]

Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 2002; 105 :2449–54. 3. Michael H. Congenital anomalies of the coronary arteries. Heart 2005; 91 :1240–5. 4. Dollar AL, Roberts WC. [bjcardio.co.uk]

Pathophysiology Advances in imaging have improved detection and classification of this heterogeneous group of disorders. [www2.ccasociety.org]

Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography. J Invasive Cardiol. 2003;15:507-14. Medline 32. [revespcardiol.org]

Pathophysiological Mechanisms and Coronary Anomalies (Functional Classification) Pathophysiological Mechanism Coronary Anomaly Proof of Action Certain Possible Unlikely ALCAPA indicates anomalous origination of the left coronary artery from the pulmonary [circ.ahajournals.org]

[…] of deaths in athletes ( Circulation 1996;94:850 ) Burke et. al. reported that in 14 to 40 year olds, coronary anomalies are involved in 12% of sports related sudden cardiac deaths versus 1.2% of non sports related deaths ( Am Heart J 1991;121:568 ) Pathophysiology [pathologyoutlines.com]

We wish we could have done something to prevent it, especially when it happens in our hometown. While hypertrophic cardiomyopathy is the leading cause of SCA in teens, there is a second-leading cause, which is not as well known. [blog.cincinnatichildrens.org]

Children’s heart conditions can’t be prevented, but a lot can be done to improve and often completely repair their hearts at any age. [nemours.org]

Medicines For patients with mild to moderate symptoms, medicines may be used, especially to prevent sudden cardiac death. Diuretics (water pills) reduce excess fluid in the body, relieving the stress on the heart’s pumping action. [texasheart.org]

Other options for surgical repair aim to prevent the coronary steal phenomenon and, ideally, to restore dual-coronary circulation. [jove.com]

Preventing sudden cardiac death in athletes: in search of evidence-based, cost-effective screening. Tex Heart Inst J 2013;40:148-55. Thompson WR. [www2.ccasociety.org]