Anomalous Left Coronary Artery Arising from the Right Coronary Sinus Presenting with Acute Coronary Syndrome

Approximately 80% of the coronary artery anomalies are not malignant and asymptomatic. Abnormal origin of the coronary artery has a variable presentation in the young population such as atypical chest pain or unexpected cardiac death. It is necessary to identify these anomalies, as lethal outcomes can be prevented with appropriate treatment and management. Left coronary artery abnormally arising from the right coronary cusp is rare and can be life-threatening if it follows the track between the aorta and pulmonary artery. The second most common cause of sudden cardiac deaths in the young population especially in athletes is coronary artery anomalies following hypertrophic obstructive cardiomyopathy. The case presented here is about abnormally arising left coronary artery following the course between the right ventricle outflow tract and aorta. The patient presented with the non-ST segment elevation-acute coronary syndrome (NSTEACS) for the first time but after 15 months he again presented with ST segment elevation-acute coronary syndrome (STE -ACS) for which he underwent Primary percutaneous coronary intervention of Right coronary artery and for anomalous left coronary artery he was managed conservatively as per patient request.