Presentation
Obese. History of diabetes and hypertension, admitted with presyncope and chest pain.
Patient Data
Left coronary system :
LM: The left main coronary artery originates from the left coronary sinus. The left main coronary artery is normal in length, of medium diameter and without calcification. The left main coronary artery is normal, without stenosis.
LAD: The left anterior descending coronary artery originates from the left main coronary artery. This artery is medium in size and regular, without calcification. This artery has two medium in size major diagonals. The proximal left anterior descending coronary artery has a mildly irregular non-flow-limiting (less than 30%) stenosis.
Circ: The left circumflex coronary artery originates from the left main coronary artery. This artery is medium in size, regular and without calcification. This artery has two medium in size major obtuse marginals. The circumflex coronary artery is free of stenosis in its proximal, and distal segments.
Right coronary system :
-
The right coronary artery originates from the left coronary sinus and courses between the aorta and the pulmonary artery. This artery is medium in size, regular and without calcification. Right artery branches are medium in size. The ostial and proximal part of the RCA has an attenuated caliber with moderate (50-70%) stenosis, likely dynamic stenosis.
Case Discussion
This case found co-dominant coronary circulation with anomalous RCA origin from the left coronary sinus, close to origin with acute angle and inter-arterial course. The ostial and proximal part of RCA has an attenuated caliber with moderate (50-70%) narrowing, likely dynamic narrowing.
Case courtesy of Dr Safwat Almoghazi MD, Radiologist, and Dr Mohammed Abdelshafi, Cardiologist.