Anomalous Malignant Right Coronary Artery with Hypertrophic Cardiomyopathy: A Rare Anaesthesiologist’s Encounter in a Patient Posted for Non-cardiac Surgery

Abstract

Abstract:Anomalous coronary arteries and hypertrophic cardiomyopathy are the leading cause of sudden cardiac death in young individuals with a high rate of autopsy diagnosis. A 38 year old male with fracture left distal end of radius presented with history of occasional palpitations and a single syncopal attack. Transthoracic echocardiography showed non-obstructive hypertrophic cardiomyopathy while CT angiography revealed anomalous inter-arterial right coronary artery. The above findings categorized the patient as extremely high risk for perioperative major cardiac event. The team of perioperative physicians in communication with the patient reached a consensus for closed reduction of the fracture with referral to a cardiothoracic center for malignant right coronary. Diligent pre-anaesthestic evaluation and team based approach helped in diagnosis of this rare life threatening entity while ultrasound guided supraclavicular block proved critical for the patient in having a favorable outcome.