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Case Reports
. 2022 Dec 11;14(12):e32418.
doi: 10.7759/cureus.32418. eCollection 2022 Dec.

Exercise-Induced Ischemic ST-Segment Elevation in Anomalous Origin of the Right Coronary Artery From the Left Sinus of Valsalva With an Intramural Course and Blocked Coronary Bypass

Kenta Hirai  1 , Daiki Ousaka  2 , Yosuke Kuroko  3 , Shingo Kasahara  3
Affiliations
Case Reports

Exercise-Induced Ischemic ST-Segment Elevation in Anomalous Origin of the Right Coronary Artery From the Left Sinus of Valsalva With an Intramural Course and Blocked Coronary Bypass

Kenta Hirai et al. Cureus. .

Abstract

Sudden cardiac events in young athletes are a major concern in the field of sports cardiology. Although coronary artery anomalies remain a major cause of cardiac events in young athletes, only a few cases have been diagnosed prior to critical events. Here, we present the case of a previously asymptomatic young male runner who experienced sudden cardiac arrest at the end of a marathon. The patient immediately received cardiopulmonary resuscitation from a bystander and was transported to an emergency hospital. As his electrocardiogram showed ventricular fibrillation, he was treated with electric shock, and his rhythm was successfully converted to a normal sinus rhythm. Following successful resuscitation, the patient was diagnosed with an anomalous origin of the right coronary artery from the left sinus of Valsalva with an intramural course. The patient underwent coronary artery bypass using the right internal thoracic artery. Fifteen years later, the coronary bypass was found to be blocked, but the patient was asymptomatic. However, an exercise electrocardiogram revealed ST-segment elevation in the inferior leads. The patient then underwent an unroofing procedure. He has remained asymptomatic without complications for two years after the second surgery.

Keywords: coronary vessel anomalies; diagnostic ct imaging; electrocardiography (ecg); sudden cardiac death; treadmill exercise test.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. (A) Two- and (B) three-dimensionally enhanced computed tomography scan showing an anomalous origin of the RCA from the left sinus of Valsalva with an intramural course. (C) Bypass of the blocked RCA using the RITA.
(A) Black and (B) white arrows indicate the origin of the RCA. (C) Black arrows indicate the bypass graft of the RITA to the RCA. RCA = right coronary artery; RITA = right internal thoracic artery; LCx = left circumflex artery
Figure 2
Figure 2. Representative exercise electrocardiograms performed according to Bruce protocol (A) before and (B) after coronary bypass obstruction.
See this image and copyright information in PMC

References

    1. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. Basso C, Maron BJ, Corrado D, Thiene G. J Am Coll Cardiol. 2000;35:1493–1501. - PubMed
    1. Cardiac arrest during long-distance running races. Kim JH, Malhotra R, Chiampas G, et al. N Engl J Med. 2012;366:130–140. - PubMed
    1. Sudden cardiac death in athletes. Schmied C, Borjesson M. J Intern Med. 2014;275:93–103. - PubMed
    1. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Circulation. 2009;119:1085–1092. - PubMed
    1. Sudden death in young adults: a 25-year review of autopsies in military recruits. Eckart RE, Scoville SL, Campbell CL, et al. Ann Intern Med. 2004;141:829–834. - PubMed

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