A 68-year-old man with a history of diabetes mellitus type II, hypertension and active smoking was transferred to our hospital from a nearby hospital for coronary artery bypass graft (CABG) surgery after suffering a complicated inferior wall myocardial infarction (IWMI). Post the initial angioplasty, the patient developed in-stent thrombosis and became hypotensive with a systolic blood pressure < 90 mmHg. After hemodynamic stability was achieved he was transferred to our hospital. During his stay, the cardiac monitor showed fluctuations in his blood pressure with a drop in systolic blood pressure by 10 to 15 mmHg and diastolic blood pressure by 10 mmHg when he developed atrioventricular (AV) dissociation during an idioventricular rhythm. Atrial kick, the fourth phase of ventricular diastole in the cardiac cycle is where the atria contributes to the ventricular end diastolic volume by atrial contraction. The significance of the atrial kick in the hemodynamics of the patient was captured on the cardiac monitor during the patient's stay in the cardiac intensive care unit.
A 49-year-old man presented to the emergency room after a cardiac arrest. On arrival, the patient’s ECG showed ST-segment elevations in the aVR and anteroseptal leads with diffuse ST depression suggestive of left main coronary artery occlusion. Subsequent coronary catheterisation showed normal coronaries but revealed severe stenosis of his bicuspid aortic valve. A surgical replacement of the aortic valve was performed, and the patient recovered successfully.
Anomalous aortic origin of coronary arteries from the opposite sinus (AAOCA) is a rare finding which, when discovered, raises questions regarding its approach and management. Modern imaging techniques can help us to identify certain anatomical features of the anomalous coronary arteries to further classify them as benign or malignant anomalies. We present a case of a 64-year-old male who had an incidental finding of AAOCA with the left anterior descending artery arising from the right coronary cusp from an ostium anterior to the one that gave rise to both the left circumflex artery and right coronary artery (RCA). The patient was managed with a percutaneous coronary intervention for an obstructive disease of the RCA and was discharged with regular follow-ups.
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