Type I dual left anterior descending coronary artery anomaly presenting with non-ST-segment elevation myocardial infarction, initially mimicking normal coronary angiogram

Abstract

A 50-year-old woman presented to our hospital with chest pain. ECG showed right bundle branch block without ST-segment elevation, and cardiac enzymes were elevated (CK-MB/troponin-T 87.2/0.06 ng/ml). Transthoracic echocardiography (see Video, Supplemental digital content 1, http://links.lww.com/MCA/ A25) showed isolated mid anteroseptal wall akinesia, whereas other myocardial segments were normal ( Fig. 1a-c). The patient was diagnosed with non-STsegment elevation myocardial infarction and admitted to the coronary care unit. Fig. 1 (a) (b) (c) (d) (e) (f) 10 5 15 10 5 10 5 V V VTransthoracic echocardiography shows reduced motion of the mid anteroseptal wall on the parasternal short axis (a), apical four-chamber (b), and apical three-chamber view (c). White lines indicate the isolated segment of reduced wall motion. Initial coronary angiography in the right anterior oblique views with cranial (d) and caudal (e) angulation resembles normal coronary arteries. However, the angiography of the right coronary artery shows extensive collateral supply to the short left anterior descending coronary artery (arrows) (f).Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.coronary-artery.com). Images in CAD 2810954-6928