Anomalous Coronary Arteries Flashcards
What is the pathophysiology of anomalous coronary artery origin?
Anomalous coronary artery origin, particularly the left coronary artery originating from the right sinus of Valsalva or the right coronary artery originating from the left sinus, creates sharp curvature.
How does anomalous coronary arteries lead to sudden cardiac death in young patients?
External compression during exertion (usually at the right sinus of Valsalva) due to the proximity of the right coranary artery to pulmonic vasculature, leading to myocardial ischemia and lethal ventricular arrhythmias.
What are the clinical clues for anomalous coronary artery origin?
Sudden collapse or syncope during high-intensity physical activity in a previously healthy individual. The patients may have exertional chest pain or lightheadedness.
What are the pertinent negatives seen with anomalous coronary artery origin?
No murmur or family history typically associated. ECG findings are often normal.
What are the risk factors for anomalous coronary artery origin?
Young athletes, high-intensity physical exertion, and anatomical variations of coronary artery origin.
What diagnostic tools are used for detecting anomalous coronary artery origin?
Transthoracic echocardiography may detect anomalies but has limitations. CT coronary angiography and cardiac MRI are the gold standards for visualizing coronary artery anatomy and confirming diagnosis.
What are the differential diagnoses for anomalous coronary artery origin?
1) Hypertrophic Cardiomyopathy (HCM)
2) Congenital Long QT Syndrome (LQTS)
3) Brugada Syndrome
4) Wolff-Parkinson-White Syndrome (WPW)
What are the 2 most significant methods for differentiating anomalous coronary artery from other conditions?
1) Anomalous coronary artery has no murmur
2) the ECG tends to be normal.
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This is not the case for the other heart diseases.
What are the most reliable diagnostic tools for identifying anomalous coronary artery origin and what are their limitations?
Transthoracic echocardiography can sometimes detect coronary anomalies but this is often insufficient. CT coronary angiography and cardiac MRI are the gold standard methods for visualizing coronary artery anatomy and confirming the diagnosis.
How can you differentiate anomalous coronary artery from HCM?
Anomalous coronary artery has no murmur and the ECG is normal. Contrastingly, HCM is distinguishable because it has a harsh crescendo-decrescendo systolic murmur that will intensify with Valsalva or by standing up abruptly. HCM also has ECG changes such as evidence of LVH (other ECG findings can be non-specific ST changes and Q-waves).
How can you differentiate anomalous coronary artery from Congenital Long QT Syndrome (LQTS) ?
Prolonged QTc (>450 ms in men, >470 ms in women) on ECG.
How can you differentiate anomalous coronary artery from Brugada Syndrome?
Brugada Syndrome has a characteristic ST elevation in V1-V3 that resembles a pseudo-RBBB.
How can you differentiate anomalous coronary artery from Wolff-Parkinson-White Syndrome (WPW)?
WPW has a short PR interval, widened QRS complex, and a Delta-wave.
