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The authors present an unusual case of chest pain in an 84-year-old Caucasian woman.
In our experience in a district general hospital, this was the first presentation of single coronary artery. This is a rare congenital abnormality which we wanted to share with the community.
The patient was an 84-year-old Caucasian woman who presented with atypical chest pain of increasing frequency and eventually occurring at rest. Her medical history included hypertension, hypercholesterolaemia and type 2 diabetes mellitus.
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 (figure 1–3). There was moderate diffuse atheroma in the left anterior descending artery but no occlusive disease.
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.
The chest pain was likely not cardiac in origin with non-flow limiting moderate coronary artery disease.
The patient remained asymptomatic and well 3 months after her presentation.
This is the first case of isolated single coronary artery in our experience. Single coronary artery as a isolated finding is a rare congenital anomaly with an incidence of 0.024–0.066%.1 2 Classification of this anomaly was initially proposed in 1979 by Lipton et al1 and further modified by Yamanaka and Hobbs3. The classifications divide the presentation into origin of the anomaly: type I: continuation of the normal artery into the missing artery's territory; type II: continuation of the anomaly from the proximal part of the other normal artery; and type III: left anterior descending and circumflex artery originating from the proximal part of the right coronary artery.
Wexham Park Hospital Catheter Lab.
Competing interests None.
Patient consent Obtained.