Cardiogenic shock in the context of newly diagnosed anomalous origin of the right coronary artery originating from the pulmonary artery: a case report

Abstract

Background Anomalous right coronary artery (RCA) from the pulmonary artery (ARCAPA) is a rare congenital heart abnormality with varying clinical presentations, for which multiple imaging modalities are often required for diagnosis. Case summary We present a case of a 76-year-old female presenting with 2 weeks of palpitations and shortness of breath who was found to be in rapid atrial fibrillation (AF) with congestive heart failure. Despite initial medical management, the patient developed cardiogenic shock with anuric renal failure. Emergent right and left heart catheterization did not demonstrate any significant obstructive coronary artery disease but showed severe right ventricular (RV) failure and raised the possibility of an ARCAPA. This diagnosis was further corroborated by findings on a subsequent transoesophageal echocardiogram. In view of profound decline and limited anticipated improvement, the patient ultimately decided to pursue comfort measures in a hospice setting. Discussion We postulate that the underlying aetiology of our patient’s shock state was multifactorial, notably progressive RCA-territory ischaemia and RV failure, sepsis, and new-onset uncontrolled AF. In adults, unrecognized congenital heart disease can uncommonly cause cardiogenic shock. In our case, echocardiography and invasive angiography were integrated for the diagnosis of ARCAPA given the clinical circumstances that limited the use of cardiac computed tomography angiography.

Cardiac imaging findings in anomalous origin of the coronary arteries from the pulmonary artery; narrative review of the literature

“…Patients were diagnosed when being evaluated for cardiovascular symptoms ranging from a simple murmur (especially in younger patients) to severe chest pain and dyspnea suggesting myocardial infarction. Patients were diagnosed by coronary angiography (13,46.4%), Echocardiography (7, 25.0%), CTA (6, 21.4%), and MRA (1, 3.6%). Reimplantation was the most performed procedure for treatment (15, 53.6%), 6 (21.4%) underwent coronary artery graft surgery (CABG), 2 (7.1%) had simple ligation, and 4 (14.3%) were treated without surgery.…”

Classification, diagnosis and clinical strategy of congenital coronary artery disease in children

“…Furthermore, according to the risk of adverse cardiac events CCAA can be separated into three kinds: benign coronary anomalies (BCA), potentially serious coronary anomalies(PSCA), serious coronary anomalies(SCA); which refers to CCAA-BCA, CCAA-PSCA and CCAA-SCA, in order to help clinicians better understand and identify the related diseases. See Table 1 for abbreviations and Table 2 for details (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”