Single Coronary Artery: An Unwonted Incidental in a 54-year-old Chronic Kidney Disease Filipino Female with ST Elevation Myocardial Infarction in Cardiogenic Shock

INTRODUCTION A single coronary artery is extremely rare. Patients with this coronary anomaly are usually asymptomatic and is commonly an incidental finding among imaging diagnostics. CASE REPORT We report a case of 56-year-old hypertensive, diabetic Filipino female on thrice-weekly maintenance hemodialysis who had a single origin coronary artery on invasive coronary angiography after she developed STEMI in cardiogenic shock along the course of her admission for an elective below knee amputation. Advised revascularization via coronary artery bypass grafting, however refused. She was eventually discharged against medical advice upon stabilization. She refused further renal replacement therapy; she succumbed two weeks later. LEARNINGS Single coronary artery is a rare condition associated with increased risk of sudden cardiac death. A multidisciplinary team in place is ideal to determine the best management strategy to employ. Guideline-directed medical therapy with aggressive risk factor control offers benefit. KEYWORDS Single coronary artery. SCA. Cardiogenic shock. ST-elevation myocardial infarction. STEMI.