Aberrant left main coronary artery induced asymptomatic heart failure

Abstract

We report a case of a malignant course of left main coronary artery in a patient presenting with sudden onset chest pain and shortness of breath. The patient is a 44-year-old African American male with a past medical history of hypertension, diabetes mellitus type 2 as well as dyslipidemia presented to the emergency department with non-exertional chest pain radiating to the left arm and shortness of breath. A coronary angiography and CT angiography (CTA) of heart was performed and it demonstrated an aberrant malignant course of the left main coronary artery coming from the right coronary ostium and coursing between the aorta and pulmonary artery. The left ventricular dysfunction was thought to be a consequence of this malignant course. Cardiothoracic surgery was consulted which determined the need for CABG. The incidence of coronary anomalies and patterns in a series of 1,950 angiograms was determined to be 5.64% with the left main coronary artery (LMCA) arising from the right sinus in 0.15% of the angiograms Diagnostic approach for malignant coronary arteries involves coronary angiography and cardiac CT. A widely accepted treatment approach for left main coronary arteries originating from the right sinus is through surgical repair. Our case urges the clinician to expand the differential diagnosis in young to middle age patient presenting with chest pain. In addition, our case reinforces the concept of the detrimental impact of malignant left coronary arteries on cardiac function. This should prompt the physician to consider coronary anomalies as a possible differential diagnosis as part of the evaluation and management of these patients.