Harshith Priyan Chandrakumar¹, Karishma Patwa², Yuvraj Singh Chowdhury², Mrinali Shetty³, Ridhima Goel¹, Jennifer Otey¹, Ahmed Awwad¹, Moro O. Salifu¹, Samy I. McFarlane^1,

Coronary artery anomalies are congenital defects which are found incidentally or after cardiac events. While these are rare abnormalities with the majority of patients remain asymptomatic and largely undiagnosed, it remains to be a major cause of sudden cardiac death (SCD). Anomalous origin of left coronary artery (ALCA) from the opposite right aortic sinus is extremely rare with less than 100 cases reported to-date. These patients are at increased risk for significant cardiac events, including SCD. In this report, we present a 48-year-old man with hypertension and marijuana use who was admitted initially with multi-lobar pneumonia and acute kidney injury, developed respiratory failure and sustained ST elevation myocardial infarction (STEMI). Coronary angiography demonstrated anomalous origin of all three main coronary arteries arising from right aortic sinus. In this report we also discuss the genesis of this rare and potentially fatal congenital abnormality and we highlight the diagnostic and management strategies available to-date.

anomalous origin of coronary arteries, anomalous left coronary artery, right coronary artery, st- elevation myocardial infarction