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Anomalies of Coronary Artery Origin

Coronary Artery Anomalous Origin


Presentation

  • 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]
  • 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]
  • 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]
  • Case 1: A 16-year-old boy presented with a long-standing history of chest discomfort, palpitations, and dizziness with exercise. He felt anxious when these events occurred and had limited his activity levels.[ctsnet.org]
Collapse
  • October 12, 2017 5 comments We’ve all read about the rare stories in the news where a teen collapses on a court or field from sudden cardiac arrest (SCA). As parents, they shake us to our very core. For cardiologists like me, they haunt us.[blog.cincinnatichildrens.org]
  • Kinking at the origin, collapse of the slit-like ostium upon exertion, intramural compression, or proximal intussusception secondary to the tangential proximal course of the artery are some other mechanisms postulated to compromise coronary blood flow[mdmag.com]
  • […] complicated by low cardiac output and new myocardial infarction that improved after coronary artery bypass, intravascular ultrasound revealed an intrinsic deformity in the intramural segment of the coronary artery that caused the initial cardiovascular collapse[www2.ccasociety.org]
Burning Pain
  • ., 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]
Shivering
  • Triggers for perioperative tachycardia including pain, hypovolemia, anemia, hyperthermia, shivering and nausea/ emesis should be avoided or promptly addressed.[www2.ccasociety.org]
Hyperthermia
  • Triggers for perioperative tachycardia including pain, hypovolemia, anemia, hyperthermia, shivering and nausea/ emesis should be avoided or promptly addressed.[www2.ccasociety.org]
Rales
  • Physical examination showed normal heart sounds and there were no rales in both lung areas. She had a blood pressure of 131/65 mm Hg, a heart rate of 69 bpm, a temperature of 36.9 C and a respiratory rate of 13/min.[openaccessjournals.com]
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]
  • References 1 Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease, Hum Pathol, 1998 , vol. 29 (pg. 689 - 95 ) 2 Congenital anomalies of the coronary arteries: report of unusual[ehjcimaging.oxfordjournals.org]
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]
  • 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]
  • 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]
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]
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]

Workup

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]

Treatment

  • 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]
  • 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]
  • Treatment of these anomalies is controversial, and there are no specific recommendations for this purpose in clinical guidelines.[revespcardiol.org]

Prognosis

  • 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]
  • ., et al. (1996) Clinical features of prognosis of Japanese patients with anomalous origin of the coronary artery. Jpn. Circ. J. 60:731-741. Karcz, R., Kohmann, A. and S.[anatomyatlases.org]

Etiology

  • 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]

Epidemiology

  • 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]
  • 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]
  • ., Talosi, L. et al. (1997) Epidemiology of congenital coronary artery anomalies: A coronary arteriography study on a central European population. Cathet. Cardiovasc. Diagn. 42:270-275.[anatomyatlases.org]
Sex distribution
Age distribution

Pathophysiology

  • 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 Sep;15(9):507-14. (26.)[aprendeenlinea.udea.edu.co]
  • […] 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]
  • Its clinical spectrum, pathology, and pathophysiology, based on a review of 140 cases with seven further cases. Circulation 38: 403-425.[omicsonline.org]

Prevention

  • 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]
  • 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]
  • 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]
  • Antibiotics are sometimes prescribed to prevent SBE. Your pediatric cardiologist will tell you whether your child needs this protection, which is often referred to as SBE prophylaxis, before and after dental or surgical procedures.[mottchildren.org]
  • Your child’s healthcare provider will give him or her medicine to help relax and prevent pain (sedation). Your child’s blood pressure and oxygen levels will be checked during the test.[stlouischildrens.org]

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