A Rare Variant of an Anomalous Origin of the Left Coronary Artery, the Great Masquerader of Angina?

Anomalous aortic origin of the coronary arteries (AAOCA) is a rare set of anatomical variants that can present with symptoms such as angina and dyspnea on exertion with complications including acute coronary syndrome and sudden cardiac death. This case demonstrates a patient presenting with classic anginal symptoms with an incidental finding of one of the rarest variants and its complexity in cannulation: a left main coronary artery arising from the non-coronary cusp. Despite insignificant left coronary disease on coronary angiography, we had a high index of suspicion for underlying coronary vasospasm as a major contributor to her recurrent symptoms. AAOCA is an anatomical finding that warrants clinician awareness and close follow-up with recommendation for surgery if symptomatic.