Single Coronary Artery Arising From the Right Coronary Cusp

Case Report

A 59-year-old male with hypertension presented to the emergency department with a 2-hour history of substernal chest pain. An electrocardiogram (ECG) showed sinus rhythm with left bundle branch block. No prior ECGs were available for comparison. His blood pressure was elevated at 210/115 mmHg; other vital signs were within normal limits. His physical exam was unremarkable. Laboratory data was remarkable for serum troponin of 0.17 ng/dL. He was taken to the cardiac catheterization lab, where he was found to have a single coronary artery coming off the right coronary cusp (Figure 1, Video 1). He did not have any obstructive lesions. His symptoms were thought to be due to a type 2 myocardial infarction from a hypertensive emergency.      

Discussion

Coronary anomalies are congenital malformations of coronary vessel anatomy, affecting the origin and course of the vessel, and seen in less than 1% of the general population. Our patient had a single coronary artery arising from the right cusp of Valsalva, branching into 3 separate ostia representing the right coronary, left anterior descending, and left circumflex arteries. The incidence of this variation is between 0.011% and 0.066%.¹ 

Reference

1. Ibrahim S, Patel N, Said S, et al. A rare case of single right coronary artery arising from the right sinus of Valsalva with severe three-vessel disease. J Geriatr Cardiol. 2017; 14(3): 218-221.

¹Clinical Assistant Professor of Medicine – University of Arizona College of Medicine, Phoenix, Arizona; ²Southwest Cardiovascular Associates, Mesa, Arizona

Disclosures: The authors report no conflicts of interest regarding the content herein.

The authors can be contacted via Nachiket Patel, MD, FACC, FACP, FSCAI, at nachiketjpatel@gmail.com.