Her ECG showed a first degree heart block with incomplete left bundle branch block morphology.
Her troponin T was 0.02 µg/l (normal range <0.03 µg/l), while the rest of her bloods were unremarkable.
A decision to perform coronary angiography was made on the basis of chest pain at rest, multiple risk factors and conduction abnormality on ECG. This revealed a congenitally absent right coronary artery (type I) with the right coronary artery continuing from the atrioventricular circumflex artery (–). There was moderate diffuse atheroma in the left anterior descending artery but no occlusive disease.
Coronary angiogram showing the left anterior descending (top) and the circumflex artery.
Coronary angiogram showing the circumflex artery transversing the posterior side of the heart.
Coronary angiogram following the circumflex artery as it transverses the coronary sulcus.
Her coronary angiogram was also complicated by ventricular fibrillation during left coronary injection which was terminated by electrical cardioversion. Although there have been no previous case reports linking risks of ventricular fibrillation with single coronary artery disease, there were also no technical problems during the procedure itself.