A young woman yr old woman with no significant pmh who presented with an NSTEMI found to have an anomalous RCA originating from the left coronary sinus. Her RCA coursed between the aorta and the pulmonary artery causing significant compression of the vessel explaining her presenting symptoms. She underwent single vessel CABG IMA to her RCA.
-Consider atypical causes of chest pain in young women: myocarditis, pericarditis, spontaneous coronary artery dissection
-Origin of the RCA from the left coronary sinus or LAD also can lead to myocardial ischemia and sudden death
-Anomalous RCA originating from the left coronary sinus makes up ~ 1% of coronary anomalies
-Noninvasive coronary magnetic resonance angiography (CMRA) is increasingly used to define anomalous coronary anatomy. Coronary angiography, which was the historical gold standard for the evaluation of the origin and course of the coronary arteries, is still recommended when other studies are not diagnostic.
Kaiser SF Internal Medicine Residency Blog 