Anomalous origin of the right coronary artery from the left coronary sinus: case report and literature review

A 41-year-old man with no relevant cardiac history presented for evaluation of episodic syncope. Electrocardiography showed sinus rhythm with right bundle-branch block and Q waves in leads II, III, and aVF. Subsequent exercise treadmill testing and technetium 99m sestamibi study revealed a reversible posterior defect. Coronary angiography later showed a right coronary artery that arose from the left coronary sinus--an anomaly that has been associated with angina, myocardial infarction, and sudden cardiac death. After being informed of the potential risks and options associated with this anomaly, the patient chose long-term beta-blocker medical therapy. At follow-up, this treatment appeared to have resolved his episodic syncope.