# Fatal Coronary Artery Anomaly Concealed in Young Athletes with Exertional Syncope

## TL;DR

A rare heart condition was found in a young athlete who experienced fainting during exercise, highlighting the importance of checking for hidden heart issues in similar cases.

## Contribution

The case highlights the importance of diagnosing anomalous aortic origin of the left main coronary artery in young athletes with syncope.

## Key findings

- Symptomatic AAOLCA-IM is associated with a high risk of sudden death.
- Exercise-related syncope should prompt cardiovascular imaging in young athletes.
- Early diagnosis and surgical repair can prevent serious outcomes.

## Abstract

Syncope is a common symptom in children, many of which are benign and do not require treatment. Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital malformation but can be a risk for serious cardiovascular events, including sudden death as well as cardiogenic syncope. Case Report. We describe the case of a 14-year-old boy who suffered an initial syncope and afebrile seizure during a soccer game. A detailed medical history and imaging studies led to the diagnosis of the anomalous aortic origin of the left main coronary artery with an intramural course (AAOLCA-IM).

Symptomatic AAOLCA-IM has the highest risk of sudden death among AAOCA, and surgical repair may be performed. Onset during exercise or preceding chest symptoms are suspicious signs of cardiogenic syncope and should be considered for cardiovascular imaging evaluation.