Left main coronary artery arising from the right coronary sinus presenting as acute coronary syndrome: A rare anomaly managed conservatively

Abstract

Coronary artery anomalies are extremely rare with a prevalence of 2.33% and they are extremely difficult to diagnose with the help of conventional tests. Once diagnosed, the associated life-threatening risks and complications that arise during surgical management are the dangers related to such anomalies. We present a case of a 45–year-old female, with chief complaints of chest pain radiating to back and left shoulder associated with palpitations for 7 days, a known case of systemic hypertension and diabetes mellitus type 2 for 7 years on regular medications. A series of investigations were conducted that included an electrocardiogram showing ischemic changes, a two-dimensional echocardiography that revealed globally dysfunctional left ventricle and an ejection fraction of 45%, and finally, a diagnostic coronary angiography leading to the diagnosis of the an abnormal origin of the left main coronary artery through the right coronary sinus associated with 80% stenotic lesion in the “left anterior descending artery” and 90% stenotic lesion in the “left circumflex artery”. The report concludes that anomalies arising from coronary arteries are extremely infrequent and difficult to diagnose. In addition, they can present with life-threatening complications during surgical management.

Keywords

• angiography
• anomalous coronary artery
• right coronary sinus