An anomalous origin of the circumflex artery from the right coronary sinus with a retroaortic course namely posterior and inferior to the left ventricular outflow tract is a relatively common coronary anomaly ^1-4. In contrast to an interarterial coronary course, which has been associated with an increased risk of sudden cardiac death, this anomaly is considered benign ^1-3.

An appearance that has been originally described for visualization of a retroaortic course of an anomalous coronary artery for the 4-chamber view on echocardiography is the "RAC sign" ⁵.

For the patient's non-obstructive coronary artery disease, we recommended aggressive risk factor modification and preventive therapy. Further stress testing with regard to the moderate stenosis of the obtuse marginal branch in the setting of symptoms is being considered. The patient is already receiving a beta-blocker, which would be a pharmacologic treatment option with regard to the myocardial bridge if this is suspected to be a contributing factor to the patient's symptoms ⁶.