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. 2015:2015:806291.
doi: 10.1155/2015/806291. Epub 2015 Jul 15.

Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature

Mahesh Anantha Narayanan  1 , Christopher DeZorzi  2 , Abhilash Akinapelli  3 , Toufik Mahfood Haddad  1 , Aiman Smer  2 , Janani Baskaran  4 , William P Biddle  3
Affiliations

Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature

Mahesh Anantha Narayanan et al. Case Rep Cardiol. 2015.

Abstract

Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV) myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery.

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Figures

Figure 1
Figure 1
Ventricular fibrillation as the initial rhythm at presentation.
Figure 2
Figure 2
EKG showing sinus rhythm with right bundle branch block, left anterior fascicular block, and nonspecific ST-T wave changes.
Figure 3
Figure 3
Coronary angiogram showing clear coronaries and anomalous left anterior descending artery originating from the right coronary cusp. RCA: right coronary artery; LAD: left anterior descending artery; PL: posterolateral branch.
Figure 4
Figure 4
Cardiac coronary CAT scan demonstrating anomalous left coronary artery originating from the right coronary cusp and coursing between aorta and pulmonary artery followed by intramural course. LAD: left anterior descending artery; RCA: right coronary artery.
See this image and copyright information in PMC

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