Malignant course of the right coronary artery
Chest pain. RFs for CAD. Equivocal stress echo.
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Malignant course of the RCA which arises from the left coronary cusp, passing at acute angle to the right between the pulmonary trunk and ascending aorta. This is causing significant proximal vessel narrowing by extrinsic compression.
Non calcified plaque in the mid LAD is causing only mild stenosis. No other CAD.
Due to the aberrant origin from the left coronary sinus, the origin is 'slit like' and the proximal vessel is narrowed due to extrinsic compression between the ascending aorta and pulmonary trunk, both of which can lead myocardial ischemia in the RCA territory.