# A Rare Case of Symptomatic Anomalous Origin of the Right Coronary Artery With a High Interarterial Course Between the Pulmonary Artery and the Aorta

## TL;DR

A 42-year-old man with a rare heart artery abnormality experienced chest pain and dizziness, which was successfully treated with surgery.

## Contribution

This case report highlights a rare anatomical anomaly and its successful surgical management.

## Key findings

- Computed tomography angiography revealed an anomalous origin of the right coronary artery with a high interarterial course.
- Symptoms were resolved after internal mammary artery-RCA bypass grafting.
- Atherosclerotic disease was confirmed during left heart catheterization.

## Abstract

The congenital anomalous origin of the right coronary artery (AORCA) with an incongruous course is a rare malformation that can manifest as exertional chest pain, syncope, arrhythmias, heart failure, and sudden cardiac death. We present a case of a 42-year-old male with a history of hypercholesterolemia who presented with chest pain and dizziness upon exertion for two weeks. The physical examination was unremarkable, and the patient was hemodynamically stable. Initial blood tests were normal. Electrocardiogram (ECG) showed sinus bradycardia at 56 bpm without ST or T wave changes. A cardiac stress test indicated antero-apical inducible ischemia with a moderate probability of stress-induced ischemia. Computed tomography angiography (CTA) revealed an AORCA with a high interarterial course between the pulmonary artery and the aorta. Subsequent left heart catheterization confirmed the anomalous origin and revealed atherosclerotic disease. This anomaly was identified as the cause of the patient’s symptoms due to the compression of the right coronary artery (RCA). The patient was treated with aspirin and statin and underwent successful internal mammary artery-RCA bypass grafting. Postoperatively, the patient’s symptoms resolved, and there were no further episodes of chest pain.