Bilal Muhammad, Saeed Aamir, Ansari Ali Z, Lief Sean, Patibandla Srihita, Sivarama Kotikalapudi, Jaiswal Abhishek
Department of Internal Medicine, Merit Health Wesley, Hattiesburg, USA.
Department of Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Cureus. 2024 Jul 19;16(7):e64940. doi: 10.7759/cureus.64940. eCollection 2024 Jul.
The congenital anomalous origin of the right coronary artery (AORCA) with an incongruous course is a rare malformation that can manifest as exertional chest pain, syncope, arrhythmias, heart failure, and sudden cardiac death. We present a case of a 42-year-old male with a history of hypercholesterolemia who presented with chest pain and dizziness upon exertion for two weeks. The physical examination was unremarkable, and the patient was hemodynamically stable. Initial blood tests were normal. Electrocardiogram (ECG) showed sinus bradycardia at 56 bpm without ST or T wave changes. A cardiac stress test indicated antero-apical inducible ischemia with a moderate probability of stress-induced ischemia. Computed tomography angiography (CTA) revealed an AORCA with a high interarterial course between the pulmonary artery and the aorta. Subsequent left heart catheterization confirmed the anomalous origin and revealed atherosclerotic disease. This anomaly was identified as the cause of the patient's symptoms due to the compression of the right coronary artery (RCA). The patient was treated with aspirin and statin and underwent successful internal mammary artery-RCA bypass grafting. Postoperatively, the patient's symptoms resolved, and there were no further episodes of chest pain.
右冠状动脉先天性异常起源（AORCA）且走行异常是一种罕见的畸形，可表现为劳力性胸痛、晕厥、心律失常、心力衰竭和心源性猝死。我们报告一例42岁男性，有高胆固醇血症病史，因劳力后胸痛和头晕两周前来就诊。体格检查无异常，患者血流动力学稳定。初始血液检查正常。心电图（ECG）显示窦性心动过缓，心率56次/分钟，无ST段或T波改变。心脏负荷试验显示前尖部诱发性缺血，负荷诱发缺血的可能性为中度。计算机断层扫描血管造影（CTA）显示AORCA，走行于肺动脉和主动脉之间的动脉间高位。随后的左心导管检查证实了异常起源，并发现了动脉粥样硬化疾病。由于右冠状动脉（RCA）受压，该异常被确定为患者症状的原因。患者接受了阿司匹林和他汀类药物治疗，并成功进行了乳内动脉-RCA搭桥手术。术后，患者症状缓解，未再出现胸痛发作。
