Kadrie Alec A, Black Skyelor, Balguri Snehitha, Cary Curtis
Internal Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, USA.
Internal Medicine, University of Tennessee at Chattanooga, Chattanooga, USA.
Cureus. 2025 Sep 10;17(9):e91982. doi: 10.7759/cureus.91982. eCollection 2025 Sep.
Coronary artery anomalies (CAAs) are rare congenital abnormalities. Certain variants, such as those with an intramural course, are associated with increased risk of ischemia and sudden cardiac death, particularly under conditions of increased cardiac demand. We report the case of a 36-year-old male with polysubstance abuse who presented with chest pain after cocaine intake. Initial labs, testing, and imaging revealed respiratory failure, hypoxia, elevated cardiac biomarkers, and new-onset reduced ejection fraction. After the patient was medically stabilized, coronary computed tomography angiography was performed, which revealed an anomalous right coronary artery (RCA) originating from the left coronary cusp with a malignant intramural course and significant stenosis. The patient was then discharged and later underwent successful surgical marsupialization of the RCA into the aorta with cardiothoracic surgery. His postoperative recovery was uncomplicated, and he was discharged with close follow-up. In this case, it is likely that cocaine-induced vasospasm exacerbated the anomaly, leading to the non-ST segment elevation myocardial infarction. This case demonstrates the importance of considering coronary anomalies in young patients with chest pain and no traditional risk factors, particularly in the setting of stimulant use. Early detection and surgical intervention are critical to prevent sudden cardiac death, and multidisciplinary care is essential for long-term success.
冠状动脉异常（CAAs）是罕见的先天性异常。某些变异型，如走行于心肌内的变异型，与缺血和心源性猝死风险增加相关，尤其是在心脏需求增加的情况下。我们报告一例36岁有多种物质滥用史的男性，在摄入可卡因后出现胸痛。初始实验室检查、检测和影像学检查显示呼吸衰竭、低氧血症、心脏生物标志物升高以及新发射血分数降低。在患者病情稳定后，进行了冠状动脉计算机断层扫描血管造影，结果显示一条异常的右冠状动脉（RCA）起源于左冠状动脉瓣叶，走行于心肌内且有恶性表现及明显狭窄。患者随后出院，之后接受了心胸外科手术，成功地将RCA袋形缝术至主动脉。他术后恢复顺利，出院时安排了密切随访。在本病例中，很可能是可卡因诱发的血管痉挛加重了这种异常，导致非ST段抬高型心肌梗死。该病例表明，对于无传统危险因素的胸痛年轻患者，尤其是在使用兴奋剂的情况下，考虑冠状动脉异常的重要性。早期检测和手术干预对于预防心源性猝死至关重要，多学科护理对于长期成功至关重要。
