title: Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature.
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.
authors.affiliation: Department of Internal Medicine, CHI Health Creighton University Medical Center, 601 North 30th Street No. 5800, Omaha, NE 68131, USA.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Anantha Narayanan
authors.affiliation: Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68102, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: DeZorzi
authors.affiliation: Cardiac Center of Creighton University, 3006Webster Street, Omaha, NE 68131, USA.
authors.forename: Abhilash
authors.initials: A
authors.lastname: Akinapelli
authors.affiliation: Department of Internal Medicine, CHI Health Creighton University Medical Center, 601 North 30th Street No. 5800, Omaha, NE 68131, USA.
authors.forename: Toufik
authors.initials: T
authors.lastname: Mahfood Haddad
authors.affiliation: Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68102, USA.
authors.forename: Aiman
authors.initials: A
authors.lastname: Smer
authors.affiliation: Sri Venkateshwaraa Medical College Hospital and Research Center, Puducherry 605102, India.
authors.forename: Janani
authors.initials: J
authors.lastname: Baskaran
authors.affiliation: Cardiac Center of Creighton University, 3006Webster Street, Omaha, NE 68131, USA.
authors.forename: William P
authors.initials: WP
authors.lastname: Biddle