Gozun Maan Kathryn L, Mizrahi Isaac, Ali Mohammed, Banerjee Dipanjan, Tsai Peter
Internal Medicine, University of Hawaii, Honolulu, USA.
Cardiology, University of Hawaii, Honolulu, USA.
Cureus. 2023 Jan 12;15(1):e33718. doi: 10.7759/cureus.33718. eCollection 2023 Jan.
Coronary artery anomalies (CAAs) are an uncommon cause of chest pain in the younger population. Misdiagnosis can be detrimental and lead to sudden cardiac deaths. We present a 62-year-old male with a past medical history significant for chest pain history with a workup in 2001 presumed to be non-cardiac in origin from bronchial asthma. He presented from a Micronesian Island for the evaluation of non-exertional chest discomfort. Further workup showed a Brugada type I pattern on ECG and ST wave depressions on anterolateral and inferior leads with associated AVR elevation on exercise stress testing. Further ischemic workup with coronary angiography revealed right dominant circulation with three-vessel coronary artery disease (CAD), including mid-left anterior descending (LAD) artery chronic total occlusion (CTO) with the right to left collaterals, left circumflex, and right coronary artery (RCA) with the accompanied anomalous origin of RCA. The patient underwent surgical correction of the anomalous RCA and coronary artery bypass grafting for the multi-vessel CAD. CAAs are usually found incidentally during ischemic workups similar to this case. Patients with CAAs can be managed conservatively with caution regarding physical activity. However, high-risk patients will warrant surgical treatment to avoid sudden cardiac death. The diagnosis of CAAs can be challenging and prone to misdiagnosis and maltreatment. It may be beneficial to pursue this in younger patients with ischemia-like symptoms. Further studies should be performed to identify the true incidence and guide medical practitioners regarding the risks, costs, and benefits of diagnosing and surgically treating CAAs in the general population.
冠状动脉异常（CAAs）是年轻人群胸痛的罕见原因。误诊可能有害并导致心源性猝死。我们报告一名62岁男性，既往有胸痛病史，2001年的检查认为其胸痛源于支气管哮喘，与心脏无关。他从密克罗尼西亚岛前来评估非劳力性胸部不适。进一步检查显示心电图呈1型Brugada模式，前侧壁和下壁导联ST段压低，运动负荷试验时伴随aVR抬高。冠状动脉造影进一步的缺血评估显示右优势型循环，三支冠状动脉疾病（CAD），包括左前降支（LAD）中段慢性完全闭塞（CTO）并伴有右向左侧支循环，左旋支和右冠状动脉（RCA），且RCA起源异常。患者接受了异常RCA的手术矫正以及多支冠状动脉疾病的冠状动脉旁路移植术。CAAs通常在类似此病例的缺血评估中偶然发现。患有CAAs的患者在进行体育活动时可谨慎地进行保守治疗。然而，高危患者需要进行手术治疗以避免心源性猝死。CAAs的诊断具有挑战性，容易误诊和误治。对于有缺血样症状的年轻患者进行此项检查可能有益。应进行进一步研究以确定其真实发病率，并就普通人群中诊断和手术治疗CAAs 的风险、成本和益处为医生提供指导。
