This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cox, I. D. Articles by Fluck, D. S. Search for Related Content PubMed PubMed Citation Articles by Cox, I. D. Articles by Fluck, D. S. Related Collections Coronary imaging: angiography/ultrasound/Doppler/CC CT and MRI Acute myocardial infarction Coronary circulation

(Circulation. 2000;102:1461.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Failed Sudden Cardiac Death in a Patient With an Anomalous Origin of the Right Coronary Artery

I. D. Cox, MRCP; N. Bunce, MRCP; D. S. Fluck, MD

From the Cardiology Department, St Peter’s Hospital, Chertsey, Surrey, UK (I.D.C., D.S.F.), and the Cardiac Magnetic Resonance Unit, Royal Brompton Hospital, London, UK (N.B.).

Correspondence to Dr I.D. Cox, Cardiology Department, St George’s Hospital, London SW17 ORE, UK. E-mail idcox@sghms.ac.uk

A64-year-old woman with no previous cardiac history suffered an out-of-hospital cardiac arrest the day after her husband died. She had previously complained of chest tightness, but an exercise ECG performed 2 months before this episode had not elicited any chest pain or ECG abnormalities. She was found in ventricular fibrillation by a paramedic ambulance crew, who successfully cardioverted her to sinus rhythm before transfer to the emergency department.

The ECG on arrival demonstrated ST segment elevation (2 mm) in the inferior leads (II, III, and aVF), which subsequently progressed to pathological Q waves. Her serum creatinine kinase rose to a maximum of 1037 IU/L on the second day of admission. Left heart catheterization demonstrated localized inferobasal hypokinesia on ventriculography; it further indicated that the right coronary artery arose anomalously from the left posterior sinus of Valsalva (Figure 1), although there were no significant coronary stenoses. Subsequent cardiac MRI (Figure 2) confirmed that the proximal segment of the right coronary artery passed between the aorta and pulmonary artery and indicated that the origin was acutely angulated.

View larger version (104K): [in this window] [in a new window]   Figure 1. Selective coronary angiograms of right coronary artery (rca) in right anterior oblique (RAO; top) and left anterior oblique (LAO; bottom) projections. The right coronary artery arises anomalously close to left main stem (lms), and right coronary ostium appears splayed in left anterior oblique projection. The left anterior descending (lad) and left circumflex (lcx) arteries can also be seen; they were faintly highlighted by radiographic contrast medium.

View larger version (111K): [in this window] [in a new window]   Figure 2. Cardiac MRI confirmed that the proximal segment . . . [Full Text of this Article]

This article has been cited by other articles:

				A. M. Gharib, V. B. Ho, D. R. Rosing, D. A. Herzka, M. Stuber, A. E. Arai, and R. I. Pettigrew Coronary Artery Anomalies and Variants: Technical Feasibility of Assessment with Coronary MR Angiography at 3 T Radiology, April 1, 2008; 247(1): 220 - 227. [Abstract] [Full Text] [PDF]

				P. Angelini Coronary Artery Anomalies: An Entity in Search of an Identity Circulation, March 13, 2007; 115(10): 1296 - 1305. [Abstract] [Full Text] [PDF]

				N. H. Bunce, C. H. Lorenz, J. Keegan, J. Lesser, E. M. Reyes, D. N. Firmin, and D. J. Pennell Coronary Artery Anomalies: Assessment with Free-breathing Three-dimensional Coronary MR Angiography Radiology, April 1, 2003; 227(1): 201 - 208. [Abstract] [Full Text] [PDF]

				C. K. L. Phoon Management of anomalous coronary artery J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1269 - 1270. [Full Text] [PDF]