Ashraf Shoaib, Salman Syeda Hafsah, Ali Nisha, Kulshreshtha Sarthak, Saad Muhammad
Internal Medicine, Bronx Care Health System Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, USA.
Internal Medicine, Bronx Care Health System, Bronx, USA.
Cureus. 2020 Dec 18;12(12):e12142. doi: 10.7759/cureus.12142.
Coronary artery anomalies (CAAs) are congenital disorders with multiple variations in the number, shape, and location of the Ostia of the coronary arterial system. The congenitally absent left main coronary artery (LMCA) is a rare anomaly that can present with benign or fatal complications ahead in life. Diagnosis and management of CAAs are sometimes challenging in low-risk patients. We present a unique case report of a 69-year-old Hispanic female who presented to the hospital with exercise-induced arrhythmia and angina symptoms. The patient complained of several episodes of chest pain, dizziness, and palpitations for a duration of two months. Electrocardiogram (EKG) and nuclear stress tests were equivocal. The angiogram revealed the separate origin of the left anterior descending artery (LAD) and left circumflex coronary artery (LCX) from the left coronary sinus. This anomaly should be considered in differentials when evaluating patients with angina symptoms. Congenital absence of LMCA is a rare condition that remains asymptomatic in the majority of the cases. It can present with exertional chest pain, palpitations, syncope, and sudden cardiac death (SCD). Occurrences of angina and arrhythmia should be carefully evaluated, and symptoms should be followed up closely. A coronary angiogram and electrophysiological testing can assist in the diagnosis.
冠状动脉异常（CAAs）是先天性疾病，冠状动脉系统开口的数量、形状和位置存在多种变异。先天性左主冠状动脉（LMCA）缺如是一种罕见的异常情况，可能在生命早期出现良性或致命并发症。在低风险患者中，CAAs的诊断和管理有时具有挑战性。我们报告一例独特病例，一名69岁的西班牙裔女性因运动诱发的心律失常和心绞痛症状入院。患者主诉胸痛、头晕和心悸发作数次，持续两个月。心电图（EKG）和核素负荷试验结果不明确。血管造影显示左前降支动脉（LAD）和左旋支冠状动脉（LCX）分别发自左冠状窦。在评估有心绞痛症状的患者时，应将这种异常情况纳入鉴别诊断。先天性LMCA缺如是一种罕见情况，大多数病例无症状。它可表现为劳力性胸痛、心悸、晕厥和心源性猝死（SCD）。应仔细评估心绞痛和心律失常的发生情况，并密切随访症状。冠状动脉造影和电生理检查有助于诊断。
