title: [Coronary artery anomaly common cause of sudden cardiac death in young people. Unusual diagnosis that requires a targeted investigation in order not to be missed].
abstract: 17-year old male was admitted after syncope during exercise, exhibiting transient ST-elevation, raised troponin T levels and regionally hypokinetic myocardium. Further investigation revealed a left main coronary artery arising from the right sinus valsalva, a narrow vessel with an intramural course resulting in compression during systole. The patient had presented previously with chest pain and syncope during physical exercise. After CT-angiography, ECG, Tilt-test and ECHO he was diagnosed with vasomotor induced syncope. Anomalous coronary arteries have been found to be one of the three most common causes of sudden cardiac death in young individuals. Symptomatic individuals present with chest pain and/or syncope on exertion. Diagnosis can be made by coronary angiography or CT angiography. Standard investigation of syncope is likely to miss the diagnosis. The management of left main coronary arising from the right sinus valsalva is generally surgical.
authors.affiliation: Södersjukhuset - VO Kardiologi Stockholm, Sweden Södersjukhuset - VO Kardiologi Stockholm, Sweden.
authors.forename: Hanna
authors.initials: H
authors.lastname: Fischer
authors.affiliation: Södersjukhuset - VO Kardiologi Stockholm, Sweden Södersjukhuset - VO Kardiologi Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Hedman
authors.affiliation: Karolinska Universitetssjukhuset, Solna - Anestesi- operations- och intensivvårdskliniken Stockholm, Sweden Karolinska Universitetssjukhuset, Solna - Anestesi- operations- och intensivvårdskliniken Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Öhman
mesh_terms: D000293:Adolescent; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D004562:Electrocardiography; D006801:Humans; D008297:Male; D013575:Syncope / Q000209:etiology; D014057:Tomography, X-Ray Computed